~ongrrssional Rrcord United States of America PROCEEDINGS AND DEBATES OF THE 102d CONGRESS, SECOND SESSION SENATE-Friday, June 12, 1992 (Legislative day of Thursday, March 26, 1992) The Senate met at 11:32 a.m. on the RECOGNITION OF THE MAJORITY Suppose my problem was a crippling expiration of the recess, and was called LEADER pain in a joint muscle, like arthritis. to order by the Honorable GEORGE J. The ACTING PRESIDENT pro tem­ Who is the best rheumatologist in your MITCHELL, a Senator from the State of pore. The majority leader is recog­ hometown-! guess that is what they Maine. nized. call them-or the best neurologist-­ that is for a muscle or nervous system PRAYER ailment--or the best otolaryngologist-­ The Chaplain, the Reverend Richard ORDER OF PROCEDURE what used to be called an eye, ear, C. Halverson, D.D., offered the follow­ Mr. MITCHELL. Mr. President, am I nose, and throat doctor, but they took ing prayer: correct in my understanding that the out the "eye" and gave them to the Let us pray. Journal has been approved to date and ophthalmologists, and now it is ear, 0 Lord, thou hast searched me, and the time for both leaders reserved for nose, and throat. known me. Thou knowest my downsitting their use later in the day? I could ask you to recommend a gas­ and mine uprising, thou understandest The ACTING PRESIDENT pro tem­ troenterologist for my heartburn and a my thought afar off. Thou compassest my pore. The majority leader is correct. cardiologist for my heart. But I doubt path and my lying down, and art ac­ you would know who are the best. Or quainted with all my ways.-Psalm 139:1- how reliable are their critical support 3. EXTENSION OF TIME FOR MORN­ specialists in radiology, anesthesi­ Eternal God, as the Senate recesses ING BUSINESS UNTIL 12:15 P.M. ology, and pathology, Yes, Mr. President, we are spending and the Senators disperse to their Mr. MITCHELL. Mr. President, under homes, their States, their scattered re­ $821 billion this year to get the best the previous order there was now to be medical care all that money has to sponsibilities, may they go in the con­ a period for morning business to extend fidence that You are with them; that offer us. And we do not know who does until12 noon. what best. You are before them and behind them; I now ask unanimous consent that So how can we reward the best with over, under, and around them. For period for morning business be ex­ our business? If we cannot tell a Kirby those who journey, grant them safe tended until12:15 p.m. today. Puckett--to use the best in baseball­ passage. Help them take time for their The ACTING PRESIDENT pro tem­ from a player like Bob Uecker, how families and for their own personal rest pore. Without objection, it is so or­ will we know where to go, which games and restoration. Make them conscious dered. to watch? Or-in most cases-what to of Your constant love and care. Mr. MITCHELL. I yield the floor. pay for a ticket. In His name who is incarnate love. Mr. DURENBERGER addressed the Kirby Puckett will end up getting $6 Amen. Chair. million a year and a player like Uecker The ACTING PRESIDENT pro tem­ a lot less. But that is not how medical APPOINTMENT OF ACTING pore. The Senator from Minnesota is care needs to work. Quality does not PRESIDING PRO TEMPORE recognized. have to cost more. We do not have to spend $6 million a The PRESIDING OFFICER. The MEASURING QUALITY IN MEDICAL year on the best cardiologist in Amer­ clerk will please read a communication ica. We simply need to send her or to the Senate from the President pro CARE him-and their colleagues-all our tempore [Mr. BYRD]. Mr. DURENBERGER. Mr. President, business. The legislative clerk.read the follow­ if someone asked you which is the best A winning baseball team draws the ing letter: hospital in this city, do you think you fans even at $15 or $20 a ticket. A loser U.S. SENATE, could answer that question with con­ does not. You get some entertainment PRESIDENT PRO TEMPORE, fidence? I might ask, Mr. President, value out of both. Sure, you get a good Washington, DC, June 12, 1992. the same question about your home game at many; even some of the losers. To the Senate: · State or your hometown in your home Under the provisions of rule I, section 3, of But the best always consistently get the Standing Rules of the Senate, I hereby State. your business at an appropriate and af­ appoint the Honorable J. ROBERT KERREY, a Suppose I were visiting in your home fordable price. Winners sell out the sta­ Senator from the State of Nebraska, to per­ and I was suddenly and seriously ill; dium because we can judge what we form the duties of the Chair. could you really do me a favor and want, and we want the best, and we ROBERT C. BYRD, refer me to the best hospital in your will decide who is the best and what we President pro tempore. community, the State of Nebraska, and are going to pay them. Mr. KERREY thereupon assumed the the city of Omaha? Could you really do But, not so in medicine. And that is chair as Acting President pro tempore. any better with your doctors? the heart of why we have a nearly 1 • This "bullet" symbol identifies statements or insertions which are not spoken by a member of the Senate on the floor. 14735 14736 CONGRESSIONAL RECORD-SENATE June 12, 1992 trillion a year problem. People have no Mayo does it right the first time. Let THE QUALITY MOVEMENT way of determining how to get value me say that again. Mayo does it right Nevertheless, the quest for genuine qual­ for their health care dollar. the first time. Its costs are 20 percent ity-of-care measures has become a full­ So, now you ask me, Mr. President, below the national average. I daresay, fledged movement. The American Hospital how do I answer the questions-if you if we sent all of our business to the Association estimates that more than 30 asked? The fact of the matter is, I real­ Mayo Clinic, they could be 40 percent states now have state-mandated health data commissions that collect quality-related in­ ly cannot. But we are beginning to below the national average. You really formation. The twin goals are to help hos­ learn how, and to learn why. It is im­ can get higher quality for less. pitals improve their performance and to portant to answer the "who is the Physicians for whom I have a great point consumers to centers where they are best" questions. deal of respect tell me time and time more likely to get the best care. In Penn­ We call it medical service values as­ again that if America ran a hospital sylvania, for instance, the state's Health sessment. It is a science or art in its and a doctor system in which the best Care Cost Containment Council is collecting infancy. But crude measures are in­ practices were rewarded with all of our information on hospital charges and patient creasingly available to all of us. The medical purchases, the prices we pay outcomes-not only to clue patients in but could be reduced by 35 percent nation­ also to help corporations identify centers Health Care Financing Administration that efficiently spend their health-care dol­ [HCFA] released its Medicare hospital wide. That is a challenge that every in­ lars. information report just last Wednes­ stitution and most medical staff and The Maryland Hospital Association's Qual­ day. HCFA cautions that its report is medical clinics should support. ity Indicator Project provides an insightful "not intended as a direct measure of I applaud this year's "best." I chal­ checklist now used by more than 600 medical quality of care," but it is best used to lenge them all. centers in 46 states. In consists of 10 yard­ generate questions from consumers Mr. President, I ask unanimous con­ sticks that hospitals-and ultimately con­ rather than make judgments on the sent to have printed in the RECORD a sumers-can use to help measure quality. quality of care. portion of the June 15, 1992, U.S. News Many are actually signs of a bad hospital, in­ & World Report article referred to. cluding such factors as the number of times Other agencies in Government, in­ patients have to return unexpectedly to op­ cluding the Agency for Health Care There being no objection, the mate­ rial was ordered to be printed in the erating rooms and cardiac-care units. Emer­ Policy and Research that we created 4 gency rooms have separate standards, such years ago, the majority leader had a RECORD, as follows: as the number of patients who have to wait major stake in that-is coming to grips AMERICA'S BEST HOSPITALS more than six hours for care. with these same questions. Even the There's no way out: Your doctor says you While the information garnered is still too joint committee on accreditation of have to be hospitalized, and a second opinion raw to help consumers much, the checklist confirms it. But where's the best place to go? seems to be pointing medical centers toward hospitals is giving us some useful infor­ Community hospitals are fine places for hav­ problem areas.