,i  #aaeth ,,congress  #b;d ,session    
,h4 ,r4 #gbec  ,,in ,,the ,,house ,,of  
,,representatives  ,december #aa1       
#bjah,mr4 ,smith of ,missouri introduced
 the following bill2 which was referred 
to the ,committee on ,ways and ,means1  
and in addition to the ,committee on    
,energy and ,commerce1 for a period to  
be subsequently determined by the       
,speaker1 in each case for consideration
 of such provisions as fall within the  
jurisdiction of the committee concerned 
,a ,,bill  ,to amend title ,,xviii of   
the ,social ,security ,act to minimize  
costs and burdens under the ,medicare   
program by providing for consideration  
of the removal of certain measures      
applicable to inpatient hospitals and   
post-acute care inpatient providers and 
providing for meaningful measures4  #a4 
,short title ,this ,act may be cited as 
the ,remove ,extraneous ,measures that  
,obstruct ,value and ,efficiency ,act or
 the ,,remove ,act4  #b4 ,removal of    
certain quality measures applicable to  

inpatient hospitals and post-acute care 
providers inpatient providers2 providing
 for meaningful measures  7a7 ,removal  
for inpatient hospitals  7#a7 ,in       
general ,section                        
#ahhf7;b77#c77;,b77viii7 of the ,social 
,security ,act 7#db ,u4,s4,c4           
#acieww7b77#c77;,b77viii77 is amended by
 adding at the end the following new    
subclause3  7,,xii7 ,for purposes of    
this clause1 in considering the removal 
of a quality measure1 the ,secretary    
shall base such consideration on factors
 such as the following3  7aa7 ,measure  
performance is so high and unvarying    
that meaningful distinctions in         
improvements in performance can no      
longer be made4  7bb7 ,performance or   
improvement on such measure does not    
result in better patient outcomes4  7cc7
 ,such measure does not align with      
clinical guidelines or practice4  7dd7  
,another measure is available that1 with
 respect to a particular topic1 is more 
broadly applicable 7across settings1    

populations1 or conditions7 than the    
measure that is being considered for    
removal for the particular topic4  7ee7 
,another measure is available that1 with
 respect to a particular topic1 is more 
proximal in time to desired patient     
outcomes than the measure that is being 
considered for removal for the          
particular topic4  7ff7 ,another measure
 is available that1 with respect to a   
particular topic1 is more strongly      
associated with desired patient outcomes
 than the measure that is being         
considered for removal for the          
particular topic4  7gg7 ,collection or  
public reporting of the measure leads to
 negative unintended consequences4  7hh7
 ,the costs 7including costs associated 
with administrative burden to providers 
of services and suppliers7 associated   
with the measure outweigh the benefit of
 the continued use of the measure4  7ii7
 ,such other factors determined         
appropriate by the ,secretary4  4  7#b7 
,value-based purchasing program ,section

 #ahhf7o77#b77;,d7 of the ,social       
,security ,act 7#db ,u4,s4,c4           
#acieww7o77#b77;,d77 is amended--  7,a7 
in the heading1 by inserting and removal
 of after ,replacing2  7,b7 by striking 
,subclause 7,,vi7 and inserting         
,subclauses 7,,vi7 and 7,,xii72 and     
7,c7 by striking such subclause applies 
and inserting such subclauses apply4    
7b7 ,removal for post-,acute care       
providers ,section #ahii;,b7h7 of the   
,social ,security ,act 7#db ,u4,s4,c4   
#acielll7h77 is amended by adding at the
 end the following new paragraph3  7#c7 
,measure removal factors  7,a7 ,in      
general ,in carrying out paragraph 7#a7 
and the provisions specified in         
subparagraph 7,b71 for purposes of      
evaluating quality measures described in
 such paragraph or such subparagraph1   
respectively1 the ,secretary shall      
consider removal of such a measure based
 on factors such as those described in  
section #ahhf7;b77#c77;,b77viii77,,xii74
  7,b7 ,reporting provisions and        

measures described ,for purposes of     
subparagraph 7,a71 the provisions and   
measures described in this subparagraph 
are the following3  7i7 ,in the case of 
inpatient rehabilitation facilities1    
section #ahhf7;j77#g7 and the measures  
described in such section4  7ii7 ,in the
 case of long-term care hospitals1      
section #ahhf7m77#e7 and the measures   
described in such section4  7iii7 ,in   
the case of skilled nursing facilities1 
section #ahhh7;e77#f7 and the measures  
described in such section4  7iv7 ,in the
 case of home health agencies1 section  
#ahie7;b77#c77;,b77v7 and the measures  
described in such section4  4  7c7      
,providing for meaningful measures      
,section #ahij;,a7a7 of the ,social     
,security ,act 7#db ,u4,s4,c4           
#acie;aaa-#a7;a77 is amended by adding  
at the end the following new paragraph3 
7#g7 ,meaningful measures ,in selecting 
and updating quality measures for use   
under this title1 the ,secretary shall1 
as practicable1 consider the extent to  

which such measures satisfy the         
following factors3  7,a7 ,the measures  
are patient-centered and meaningful to  
patients1 clinicians1 and providers4    
7,b7 ,the measures address high-impact  
measure areas that safeguard public     
health4  7,c7 ,the measures are         
outcome-based where possible4  7,d7 ,the
 measures minimize the level of burden  
for providers4  7,e7 ,the measures      
create significant opportunity for      
improvement2  7,f7 ,the measures align  
across programs and with other payors4  
7,g7 ,the measures satisfy any other    
factor specified by the ,secretary4  4