113 S2966 IS: Critical Care Assessment and Improvement Act of 2014
U.S. Senate
2014-11-20
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.
1.
This Act may be cited as the
Critical Care Assessment and Improvement Act of 2014
.
2.
(a)
Congress finds the following:
(1)
Critical care
medicine is the care for patients whose illnesses or injuries present a
significant danger to life, limb, or organ function and require
comprehensive
care and constant monitoring, usually in intensive care units (ICUs).
(2)
Each year,
approximately 5,000,000 people in the United States are admitted into
adult medical,
surgical,
pediatric, or neonatal ICUs.
(3)
Critical care
medicine encompasses a wide array of diseases and health issues. The care
provided in the ICU is highly specialized and complex due to the extreme
severity of illness of its patient population, often involving multiple
disease
processes in different organ systems at the same time.
(4)
Critical care
medicine consumes a significant amount of financial resources, accounting
for
more than 17 percent of all hospital costs.
(5)
According to a
2006 report by the Health Resources and Services Administration
(referred to in this section as HRSA
), demand in the United States for critical care medical
services is on the rise, due in part to the growing elderly population, as
individuals over the age of 65 consume a large percentage of critical care
services.
(6)
The HRSA report
also found that the growing aging population will further exacerbate an
existing shortage of intensivists, the physicians certified in critical
care
who primarily deliver care in intensive care units, potentially
compromising
the quality and availability of care. Today, intensivist-led teams treat
only
one-third of critically ill patients despite substantial evidence that
these
teams lead to improved outcomes.
(7)
Ensuring the
strength of our critical care medical delivery infrastructure is integral
to
the improvement of the quality and delivery of health care in the United
States.
(b)
The purpose of this Act is to assess the
current state of the United States critical care medical delivery system
and
implement policies to improve the quality and effectiveness of care
delivered
to the critically ill and injured.
3.
(a)
Institute of
Medicine study
(1)
The Secretary of
Health and Human Services (in this Act referred to as the
Secretary) shall enter into an agreement with the Institute of
Medicine under which, not later than 1 year after the date of the
enactment of
this Act, the Institute will—
(A)
conduct an
analysis of the current state of critical care health services in the
United
States;
(B)
develop
recommendations to bolster critical care capabilities to meet future
demand;
and
(C)
submit to Congress
a report including the analysis and recommendations under subparagraphs
(A) and
(B).
(2)
The agreement under paragraph (1) shall, at a minimum,
provide for the following:
(A)
Analysis of the
current critical care system in the United States, including—
(i)
the
system’s capacity and resources, including the size of the critical care
workforce and the availability of health information technology and
medical
equipment;
(ii)
the
system’s strengths, limitations, and future challenges; and
(iii)
the system’s
ability to provide adequate care for the critically ill or injured in
response
to a national health emergency, including a pandemic or natural
disaster.
(B)
Analysis and
recommendations regarding regionalizing critical care systems.
(C)
Analysis regarding
the status of critical care research in the United States and
recommendations
for future research priorities.
(b)
Health Resources
and Services Administration study
(1)
The Secretary shall review and update the
Health Resources and Services Administration’s 2006 study entitled The Critical Care Workforce: A Study
of the Supply and Demand for Critical Care Physicians.
(2)
In
carrying out paragraph (1), the Secretary shall expand the scope of the
study
to address the supply and demand of other providers within the spectrum of
critical care delivery, such as critical care nurses, mid-level
providers
(such as physician assistants and nurse practitioners), intensive care
unit
pharmacists, and intensive care unit respiratory care practitioners.
4.
NIH Critical Care
Coordinating Working Group
(a)
The Secretary shall establish a working group within the
National Institutes of Health to be known as the Critical Care
Coordinating Working Group (in this
section referred to as the Working Group).
(b)
The
Secretary shall ensure that the membership of the Working Group includes
representatives throughout the National Institutes of Health and any other
component of the Department of Health and Human Services, as the
Secretary determines appropriate to increase agency coordination on
critical care, and based on existing resources, such as—
(1)
the National
Heart, Lung, and Blood Institute;
(2)
the National
Institute of Nursing Research;
(3)
the Eunice Kennedy Shriver National
Institute of Child Health and Human Development;
(4)
the National Institute of General Medical
Sciences;
(5)
the National
Institute on Aging; and
(6)
the National Institute of Minority Health.
(c)
The
Working Group shall—
(1)
serve as the focal
point and catalyst across the National Institutes of Health and any other
component of the Department of Health and Human Services, as the
Secretary determines appropriate for advancing
research and research training in the critical care setting;
(2)
coordinate funding opportunities that
involve multiple components of the Department of Health and Human
Services;
(3)
catalyze the
development of new funding opportunities;
(4)
inform
investigators about funding opportunities in their areas of interest;
(5)
represent the
National Institutes of Health in government-wide efforts to improve the
Nation’s critical care system;
(6)
coordinate the
collection and analysis of information on current research of the National
Institutes of Health relating to the care of the critically ill and
injured and
identify gaps in such research;
(7)
provide an annual
report to the Director of the National Institutes of Health regarding
research
efforts of the Institutes relating to the care of the critically ill and
injured; and
(8)
make
recommendations in each such report on how to strengthen partnerships
within
the National Institutes of Health and between the Department of Health and
Human Services and public
and
private entities to expand collaborative, cross-cutting research.
5.
Centers for
Medicare and Medicaid Innovation Critical Care Demonstration project
(a)
Not later than one
year after the date of the enactment of this Act, the Secretary shall
carry out a demonstration
project under Section 1115A of the Social Security Act (42 U.S.C. 1315a),
designed to improve the quality and efficiency of care provided to
critically ill and injured patients receiving critical care in intensive
care
units or other areas of acute care hospitals.
(b)
Activities under
demonstration project
The activities conducted under the
demonstration project under subsection (a) may, in addition to any other
activity specified by the Center for Medicare and Medicaid Innovation,
include
activities that seek to—
(1)
improve the
coordination and transitions of care to and from an intensive care unit
and the
next point of care;
(2)
incorporate
value-based purchasing methodologies or novel informatics, monitoring, or
other
methodologies to eliminate error, improve outcomes, and reduce waste from
the
delivery of critical care;
(3)
improve prediction
models that help health care providers and hospitals identify patients at
high
risk for requiring critical care services and streamline care delivery to
prevent unexpected hospital readmissions for critical illnesses; and
(4)
utilize bundled
payment approaches and incentive care redesign, such as efforts to
facilitate
and support comprehensive team delivered care.