S 1020 ISCommentsClose CommentsPermalink

To optimize the delivery of critical care medicine and expand the critical care workforce.CommentsClose CommentsPermalink

May 12, 2009CommentsClose CommentsPermalink

Mr. WHITEHOUSE (for himself, Mr. CRAPO, and Mr. GRAHAM) introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and PensionsCommentsClose CommentsPermalink

To optimize the delivery of critical care medicine and expand the critical care workforce.CommentsClose CommentsPermalink

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,CommentsClose CommentsPermalink

SECTION 1. SHORT TITLE.

This Act may be cited as the ‘Patient-Focused Critical Care Enhancement Act’.CommentsClose CommentsPermalink

SEC. 2. PURPOSE.

The purpose of this Act is to optimize the delivery of critical care medicine and expand the critical care workforce.CommentsClose CommentsPermalink

SEC. 3. FINDINGS.

Based on the Health Resources and Services Administration’s May 2006 Report to Congress, The Critical Care Workforce: A Study of the Supply and Demand for Critical Care Physicians, Congress makes the following findings:CommentsClose CommentsPermalink





(1) In 2000, an estimated 18,000,000 inpatient days of ICU care were provided in the United States through approximately 59,000 ICU beds in 3,200 hospitals.CommentsClose CommentsPermalink





(2) Patient outcomes and the quality of care in the ICU are related to who delivers that care and how care is organized.CommentsClose CommentsPermalink





(3) The demand in the United States for critical care medical services is rising sharply and will continue to rise sharply largely as a result of the following 3 factors:CommentsClose CommentsPermalink





(A) There is strong evidence demonstrating improvements in outcomes and efficiency when intensive care services are provided by nurses and intensivist physicians who have advanced specialty training in critical care medicine.CommentsClose CommentsPermalink





(B) The Leapfrog Group, health care payors, and providers are encouraging greater use of such personnel in intensive care settings.CommentsClose CommentsPermalink





(C) Critical care services are overwhelmingly consumed by patients over the age of 65 and the aging of the United States population is driving demand for these services.CommentsClose CommentsPermalink





(4) The future growth in the number of critical care physicians in ICU settings will be insufficient to keep pace with growing demand.CommentsClose CommentsPermalink





(5) This growing shortage of critical care physicians presents a serious threat to the quality and availability of health care services in the United States.CommentsClose CommentsPermalink





(6) This shortage will disproportionately impact rural and other areas of the United States that already often suffer from a suboptimal level of critical care services.CommentsClose CommentsPermalink

SEC. 4. RESEARCH.

(a) In General- The Secretary of Health and Human Services, through the Agency for Healthcare Research and Quality, shall conduct research to assess--CommentsClose CommentsPermalink





(1) the standardization of critical care protocols, intensive care unit layout, equipment interoperability, and medical informatics;CommentsClose CommentsPermalink





(2) the impact of differences in staffing, organization, size, and structure of intensive care units on access, quality, and efficiency of care; andCommentsClose CommentsPermalink





(3) coordinated community and regional approaches to providing critical care services, including approaches whereby critical care patients are assessed and provided care based upon intensity of services required.CommentsClose CommentsPermalink





(b) Report- Not later than 18 months after the date of enactment of this Act, the Director of the Agency for Healthcare Research and Quality shall submit a report to Congress, that, based on the review under subsection (a), evaluates and makes recommendations regarding best practices in critical care medicine.CommentsClose CommentsPermalink

SEC. 5. INNOVATIVE APPROACHES TO CRITICAL CARE SERVICES.

The Secretary of Health and Human Services shall undertake the following demonstration projects:CommentsClose CommentsPermalink





(1) OPTIMIZATION OF CRITICAL CARE SERVICES-CommentsClose CommentsPermalink





(A) IN GENERAL- The Administrator of the Centers for Medicare & Medicaid Services shall solicit proposals submitted by inpatient providers of critical care services who propose to demonstrate methods to optimize the provision of critical care services to Medicare beneficiaries through innovations in such areas as staffing, ICU arrangement, and utilization of technology.CommentsClose CommentsPermalink





(B) FUNDING OF PROPOSALS- The Administrator of the Centers for Medicare & Medicaid Services shall fund not more than 5 proposals, not less than 1 of which shall focus on the training of hospital-based physicians in rural or community, or both, hospital facilities in the provision of critical care medicine. Such projects shall emphasize outcome measures based on the Institute of Medicine’s following 6 domains of quality care:CommentsClose CommentsPermalink





(i) Care should be safe.CommentsClose CommentsPermalink





(ii) Care should be effective.CommentsClose CommentsPermalink





(iii) Care should be patient-centered.CommentsClose CommentsPermalink





(iv) Care should be timely.CommentsClose CommentsPermalink





(v) Care should be efficient.CommentsClose CommentsPermalink





(vi) Care should be equitable.CommentsClose CommentsPermalink





(2) FAMILY ASSISTANCE PROGRAMS FOR THE CRITICALLY ILL-CommentsClose CommentsPermalink





(A) IN GENERAL- The Secretary of Health and Human Services shall solicit proposals and make an award to support a consortium consisting of 1 or more providers of inpatient critical care services and a medical specialty society involved in the education and training of critical care providers.CommentsClose CommentsPermalink





(B) MEASUREMENT AND EVALUATION- A provider that receives support under subparagraph (A) shall measure and evaluate outcomes derived from a ‘family-centered’ approach to the provision of inpatient critical care services that includes direct and sustained communication and contact with beneficiary family members, involvement of family members in the critical care decisionmaking process, and responsiveness of critical care providers to family requests. Such project shall evaluate the impact of a family-centered, multiprofessional team approach on, and the correlation between--CommentsClose CommentsPermalink





(i) family satisfaction;CommentsClose CommentsPermalink





(ii) staff satisfaction;CommentsClose CommentsPermalink





(iii) length of patient stay in an intensive care unit; andCommentsClose CommentsPermalink





(iv) cost of care.CommentsClose CommentsPermalink





(C) OUTCOME MEASURES- A provider that receives support under subparagraph (A) shall emphasize outcome measures based on the Institute of Medicine’s following 6 domains of quality care:CommentsClose CommentsPermalink





(i) Care should be safe.CommentsClose CommentsPermalink





(ii) Care should be effective.CommentsClose CommentsPermalink





(iii) Care should be patient-centered.CommentsClose CommentsPermalink





(iv) Care should be timely.CommentsClose CommentsPermalink





(v) Care should be efficient.CommentsClose CommentsPermalink





(vi) Care should be equitable.CommentsClose CommentsPermalink

SEC. 6. USE OF TELEMEDICINE TO ENHANCE CRITICAL CARE SERVICES IN RURAL AND UNDERSERVED AREAS.

(a) Amendment to Rural Utilities Service Distance Learning and Telemedicine Program- Chapter 1 of subtitle D of title XXIII of the Food, Agriculture, Conservation, and Trade Act of 1990 (7 U.S.C. 950aaa et seq.) is amended by adding at the end the following:CommentsClose CommentsPermalink

‘SEC. 2335B. ADDITIONAL AUTHORIZATION OF APPROPRIATIONS FOR TELEMEDICINE CRITICAL CARE INITIATIVES.

‘In addition to amounts authorized under section 2335A, there is authorized to be appropriated $5,000,000 in each of fiscal years 2010 through 2015 to carry out telemedicine initiatives under this chapter whereby 1 or more providers of inpatient critical care services in rural or other medically underserved areas propose, through collaboration with other providers, to augment the delivery of critical care services in the rural or other medically underserved area inpatient setting through the use of telecommunications systems that allow for consultation with critical care providers not located in the rural or other medically underserved area facility regarding the care of such patients.’.CommentsClose CommentsPermalink





(b) Amendment to Telehealth Network Grant Program- Section 330I(i)(1)(B) of the Public Health Service Act (42 U.S.C. 254c-14(i)(1)(B)) is amended by striking the period at the end and inserting ‘, or that augment the delivery of critical care services in rural or other medically underserved area inpatient settings through consultation with providers located elsewhere.’.CommentsClose CommentsPermalink

SEC. 7. INCREASING THE SUPPLY OF CRITICAL CARE PROVIDERS.

Section 338B of the Public Health Service Act (42 U.S.C. 254l-1) is amended by adding at the end the following:CommentsClose CommentsPermalink





‘(i) Critical Care Initiative-CommentsClose CommentsPermalink





‘(1) ESTABLISHMENT- The Secretary shall undertake an initiative that has as its goal the annual recruitment of not less than 50 providers of critical care services into the National Health Service Corps Loan Repayment Program. Providers recruited pursuant to this initiative shall be additional to, and not detract from, existing recruitment activities otherwise authorized by this section.CommentsClose CommentsPermalink





‘(2) CLARIFYING AMENDMENT- The initiative described in paragraph (1) shall be undertaken pursuant to the authority of this section, and for purposes of the initiative--CommentsClose CommentsPermalink





‘(A) the term ‘primary health services’ as used in subsection (a) shall be understood to include critical care services; andCommentsClose CommentsPermalink





‘(B) ‘an approved graduate training program’ as that term is used in subsection (b)(1)(B) shall be limited to pulmonary fellowships or critical care fellowships, or both, for physicians.’.CommentsClose CommentsPermalink

SEC. 8. AUTHORIZATION OF APPROPRIATIONS.

There are authorized to be appropriated to carry out this Act--CommentsClose CommentsPermalink





(1) $5,000,000 for the research to be conducted under section 4; andCommentsClose CommentsPermalink





(2) $4,000,000 for the demonstration projects authorized under section 5.CommentsClose CommentsPermalink