1.This Act may be cited as the
Patient-Focused Critical Care
Enhancement Act
.
2.The purpose of this Act is to optimize the
delivery of critical care medicine and expand the critical care
workforce.
3.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, the Senate makes
the following findings:
(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.
(2)Patient outcomes and the quality of care in
the ICU are related to who delivers that care and how care is organized.
(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:
(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.
(B)The Leapfrog Group, health care payors, and
providers are encouraging greater use of such personnel in intensive care
settings.
(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.
(4)The future growth in the number of critical
care physicians in ICU settings will be insufficient to keep pace with growing
demand.
(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.
(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.
4.
(a)The Secretary of Health and Human Services,
through the Agency for Healthcare Research and Quality, shall conduct research
to assess—
(1)the standardization of critical care
protocols, intensive care unit layout, equipment interoperability, and medical
informatics;
(2)the impact of differences in staffing,
organization, size, and structure of intensive care units on access, quality,
and efficiency of care; and
(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.
(b)Not later than 18 months after the date of
enactment of this Act, 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.
5.Innovative approaches to critical care
servicesThe Secretary of
Health and Human Services shall undertake the following demonstration
projects:
(1)Optimization of critical care
services
(A)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.
(B)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:
(i)Care should be safe.
(ii)Care should be effective.
(iii)Care should be patient-centered.
(iv)Care should be timely.
(v)Care should be efficient.
(vi)Care should be equitable.
(2)Family assistance programs for the
critically ill
(A)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.
(B)Measurement and evaluationA 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—
(i)family satisfaction;
(ii)staff satisfaction;
(iii)length of patient stay in an intensive care
unit; and
(iv)cost of care.
(C)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:
(i)Care should be safe.
(ii)Care should be effective.
(iii)Care should be patient-centered.
(iv)Care should be timely.
(v)Care should be efficient.
(vi)Care should be equitable.
6.Use of telemedicine to enhance critical
care services in rural areas
(a)Amendment to rural utilities service
distance learning and telemedicine programChapter 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:
2335B.Additional authorization of appropriations
for telemedicine critical care initiativesIn addition to amounts authorized under
section 2335A, there is authorized to be appropriated $5,000,000 in each of
fiscal years 2008 through 2013 to carry out telemedicine initiatives under this
chapter whereby 1 or more rural providers of inpatient critical care services
propose, through collaboration with other providers, to augment the delivery of
critical care services in the rural inpatient setting through the use of
telecommunications systems that allow for consultation with critical care
providers not located in the rural facility regarding the care of such
patients.
.
(b)Amendment to telehealth network grant
programSection 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 inpatient settings through
consultation with providers located elsewhere.
.
7.Increasing the supply of critical care
providersSection 338B of the
Public Health Service Act (42 U.S.C. 254l–1) is amended by adding at the end
the following:
(i)
(1)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.
(2)The initiative described in paragraph (1)
shall be undertaken pursuant to the authority of this section, and for purposes
of the initiative—
(A)the term primary health
services as used in subsection (a) shall be understood to include
critical care services; and
(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.
.
8.Authorization of
appropriationsThere are
authorized to be appropriated to carry out this Act—
(1)$5,000,000 for the research to be conducted
under section 4; and
(2)$4,000,000 for the demonstration projects
authorized under section 5.