[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2948 Introduced in House (IH)]

111th CONGRESS
  1st Session
                                H. R. 2948

 To amend title IX of the Public Health Service Act to provide for the 
implementation of best practices in the delivery of health care in the 
                 United States, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             June 18, 2009

   Mr. Levin (for himself, Mr. Higgins, Mr. Doggett, Ms. Hirono, Mr. 
 Pomeroy, and Mr. Etheridge) introduced the following bill; which was 
            referred to the Committee on Energy and Commerce

_______________________________________________________________________

                                 A BILL


 
 To amend title IX of the Public Health Service Act to provide for the 
implementation of best practices in the delivery of health care in the 
                 United States, and for other purposes.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Healthcare Improvements for 
Generating High Performance (HIGH Performance) Act of 2009''.

SEC. 2. FINDINGS.

    The Congress finds the following:
            (1) The United States has some of the best doctors and 
        hospitals in the world, but, as a whole, the system is not 
        providing the quality of care it has the potential to deliver.
            (2) On average, patients receive recommended evidence-based 
        therapies only 55 percent of the time.
            (3) In the United States, it takes an average of 17 years 
        for an established clinical guideline to reach the bedside.
            (4) More people die from medical errors and hospital-
        acquired infections in a given year than from AIDS, motor 
        vehicle wrecks, or breast cancer combined. Many of these errors 
        and infections are preventable when best practices are 
        utilized.
            (5) The United States ranks far behind other countries in 
        many measures of health care quality.
            (6) The cause of poor quality is not a lack of individual 
        commitment, but a lack of assistance for providers to implement 
        best practices that are proven to work.
            (7) Experiences in Michigan illustrate the improvement that 
        can be achieved when hospitals and physicians have the tools 
        they need to implement best practices in health care. After 
        Michigan instituted a program to help hospitals implement best 
        practices to prevent hospital-acquired infections in the 
        intensive care unit (ICU), infections went down by 66 percent 
        in the first 3 months. After 18 months, Michigan's ICUs cut 
        infection rates so low that they outperformed 90 percent of 
        ICUs nationwide.
            (8) In that time, it is estimated that Michigan hospitals 
        saved $75,000,000 and over 1,500 lives. If these results in 
        reducing infections alone were achieved nationwide, it is 
        estimated that the United States could save $13,000,000,000 
        over 10 years.
            (9) There is an urgent need to accelerate the 
        implementation of best practices in health care delivery to 
        improve the quality and value of health care.

SEC. 3. IMPLEMENTATION OF BEST PRACTICES TO IMPROVE HEALTH CARE 
              QUALITY.

    Title IX of the Public Health Service Act (42 U.S.C. 299 et seq.) 
is amended by adding at the end the following:

   ``PART E--IMPLEMENTATION OF BEST PRACTICES TO IMPROVE HEALTH CARE 
                                QUALITY

``SEC. 941. ESTABLISHMENT OF NATIONAL PRIORITIES AND GOALS.

    ``(a) In General.--The Secretary shall establish national 
priorities and goals for quality improvement in the delivery of health 
care services in the United States. In establishing these priorities 
and goals, the Secretary shall consult with a multistakeholder group 
convened for the purposes of reviewing available evidence and 
recommending national quality improvement targets. Such group shall 
include representatives of the various interests and organizations 
needed to enable change, including consumers, physicians, nurses, 
hospitals and other care delivery organizations, non-Federal purchasers 
of care, health care oversight or accrediting bodies, research 
organizations, and entities with successful experience in quality 
improvement and quality measurement.
    ``(b) Areas for Improvement.--Priorities and goals may be 
established in at least the following areas recommended by the 
Institute of Medicine: safety, effectiveness, patient-centeredness, 
timeliness, efficiency, and equity.
    ``(c) Periodic Updates of National Priorities and Goals.--The 
Secretary shall update the national priorities and goals established 
under this section not less frequently than once every 3 years.
    ``(d) Application of National Priorities.--The Secretary shall use 
the national priorities established and updated under this section to 
coordinate, accelerate, and provide for quality improvement activities 
and initiatives in the delivery of health care services in the United 
States, including through the work of the Center for Health Extension 
established under section 942.
    ``(e) Assessment of Progress Toward National Goals.--The Secretary 
shall submit an annual report to the Congress and the public containing 
an assessment of progress toward the national quality improvement 
goals.
    ``(f) Interagency Coordination.--The Secretary shall convene an 
interagency committee, which shall include representatives from the 
Agency for Healthcare Research and Quality, including the Center for 
Health Extension established under section 942, the National Institutes 
of Health, the Centers for Disease Control and Prevention, the Centers 
for Medicare and Medicaid Services, the Health Resources and Services 
Administration, the Indian Health Service, the Department of Defense, 
the Veterans Health Administration, and other agencies the Secretary 
deems appropriate, for the purpose of coordinating the quality 
improvement work of such agencies, including the application of the 
national priorities.

``SEC. 942. ESTABLISHMENT OF THE CENTER FOR HEALTH EXTENSION.

    ``(a) Establishment.--The Secretary shall establish within the 
Agency for Healthcare Quality and Research a Center for Health 
Extension (hereinafter referred to as the `Center').
    ``(b) Director.--The Center shall be headed by a Director who shall 
oversee the operations of the Center and of the Regional Health 
Extension Centers established under section 944.

``SEC. 943. MISSION AND FUNCTIONS OF THE CENTER FOR HEALTH EXTENSION.

    ``(a) Mission.--The mission of the Center is to improve health care 
quality by assisting health care providers to implement and improve 
upon clinical, managerial, and health care delivery best practices, and 
to evaluate progress in improving patient outcomes.
    ``(b) Functions.--
            ``(1) Identify and develop best practices.--The Center 
        shall identify and develop clinical, managerial, and health 
        care delivery best practices for implementation in quality 
        improvement activities.
            ``(2) Assist with the implementation of best practices.--
        The Center shall provide voluntary training and technical 
        assistance to hospitals, other health care facilities, and 
        clinician practices to assist with the implementation of best 
        practices.
            ``(3) Measure patient outcomes and satisfaction.--The 
        Center shall provide for the measurement of patient outcomes 
        and satisfaction, before, during, and after implementation of 
        quality improvement activities.
            ``(4) Evaluate effectiveness of activities.--The Center 
        shall evaluate the effectiveness of quality improvement 
        activities, and progress improving patient outcomes.
    ``(c) Identification of Best Practices.--
            ``(1) In general.--The Center shall provide for the 
        identification of highly effective clinical, managerial, and 
        health care delivery practices and innovations that result in 
        excellent patient outcomes and satisfaction, and can be adapted 
        for use by various health care providers.
            ``(2) Sources of best practices.--The Center may identify 
        practices and innovations described in paragraph (1) from the 
        following sources.
                    ``(A) Providers and other health care entities.--
                The Center may identify practices and innovations 
                employed by hospitals, health care facilities, 
                clinician practices, community cooperatives, and other 
                health care entities.
                    ``(B) Empirical studies.--The Center may identify 
                practices and innovations from a review of relevant 
                empirical studies.
                    ``(C) Public and private entities.--The Center may 
                identify practices and innovations developed by public 
                and private entities in the United States and abroad.
                    ``(D) Other sources.--The Center may identify 
                practices and innovations from other sources as the 
                Secretary deems appropriate.
    ``(d) Development of Best Practices.--
            ``(1) In general.--The Center shall provide for the 
        development of highly effective clinical, managerial, and 
        health care delivery practices, taking into account the 
        requirements described in paragraph (2).
            ``(2) Requirements.--Practices developed under paragraph 
        (1) shall--
                    ``(A) be supported by empirical evidence showing 
                that they have a high likelihood of improving patient 
                outcomes and satisfaction;
                    ``(B) be specified with sufficient detail of the 
                individual processes, steps, training, skills, and 
                knowledge required for implementation and incorporation 
                into workflow of health care practitioners in a variety 
                of settings;
                    ``(C) be designed to be readily adapted by health 
                care practitioners;
                    ``(D) where applicable, be designed to be 
                consistent with standards adopted by the Secretary 
                (under section 3004 of the Public Health Service Act) 
                for health information technology used in the 
                collection and reporting of quality information, 
                including for purposes of the demonstration of 
                meaningful use of certified Electronic Medical Record 
                technology by physicians and hospitals under the 
                Medicare program (under sections 1842(o)(2) and 
                1886(n)(3), respectively, of the Social Security Act 
                (42 U.S.C. 1395w-4(o)(2), 1395ww(n)(3))); and
                    ``(E) where applicable, assist health care 
                practitioners in working with other health care 
                practitioners across the continuum of care and in 
                engaging patients and their families in improving the 
                care and patient outcomes.
            ``(3) Collaboration with health care providers and other 
        entities.--The Center may collaborate with health care 
        providers and other entities to foster the development of 
        highly effective practices and innovations to improve health 
        care quality.
            ``(4) Attention to health care delivery design.--The Center 
        shall specifically provide for the development of best 
        practices for health care delivery design as described in 
        section 943(g).
            ``(5) Ongoing review and improvement.--The Center shall 
        provide for regular review, updating, and improvement of 
        practices developed under this subsection.
    ``(e) Training and Education for Health Care Providers.--
            ``(1) In general.--Acting through the Regional Health Care 
        Extension Centers established in section 944 (hereinafter 
        referred to as `Extension Centers'), the Center shall provide 
        for voluntary training activities for hospitals, other 
        facilities, and clinician practices to assist with the 
        implementation of best practices and innovations identified 
        under subsection (c) or developed under subsection (d) that--
                    ``(A) further the priorities established under 
                section 941, once such priorities have been 
                established;
                    ``(B) have the greatest impact on patient outcomes 
                and satisfaction; and
                    ``(C) are determined to be readily employable in 
                health care settings.
            ``(2) Technical assistance.--The Center shall work through 
        the Extension Centers to carry out the following functions:
                    ``(A) Establishment of participation.--The 
                Extension Centers shall seek the voluntary 
                participation of hospitals, health facilities, and 
                clinician practices in a region to enter into 
                arrangements to receive assistance in implementing 
                highly effective practices identified under subsection 
                (c) or developed under subsection (d). Hospitals, 
                health facilities, and clinician practices entering 
                into such arrangements are hereinafter referred to in 
                this subsection as `collaborating providers'.
                    ``(B) Establishment of collaborative team.--The 
                Extension Centers may require collaborating providers 
                to designate a group of members from among the 
                professional and administrative staff who are 
                responsible for the implementation of the quality 
                improvement activity or initiative.
                    ``(C) Assessment of existing practices.--The 
                Extension Centers shall conduct an assessment of the 
                existing practices as compared to the identified highly 
                effective practice at each hospital, facility, or 
                practice that participates in an arrangement under this 
                subsection.
                    ``(D) Development of implementation plan.--Each 
                collaborating provider shall work with the Extension 
                Center to develop an implementation plan for the 
                incorporation of the highly effective practice into the 
                care of the provider.
                    ``(E) Training for collaborating providers.--Staff 
                of the Extension Center shall work with the 
                collaborating providers to execute the implementation 
                plan. Such staff shall provide instruction and training 
                through electronic media, in-person training sessions, 
                and data analysis to collaborating providers. Such 
                staff shall work with the collaborating providers to 
                carry out this paragraph.
                    ``(F) Measurement of progress.--Pursuant to a data 
                protection agreement entered into between the Extension 
                Center and the collaborating provider, the Extension 
                Center shall collect data to measure best practice 
                implementation and patient outcomes before, during, and 
                after implementation of quality improvement activities 
                using, to the extent practicable, data already reported 
                for other purposes by collaborating providers. Where 
                applicable, the Extension Center shall also collect 
                data to measure the culture of safety.
                    ``(G) Timely feedback to collaborating providers.--
                The Extension Center shall provide to each 
                collaborating provider--
                            ``(i) analysis conducted by the Extension 
                        Center on the collaborating provider's progress 
                        implementing the highly effective practice and 
                        improving patient outcomes, and, where 
                        applicable, improving the culture of safety.
                            ``(ii) information on the collaborating 
                        provider's performance as compared to other 
                        like entities participating in similar quality 
                        improvement activities, and as available, as 
                        compared to other like entities nationally.
                    ``(H) Culture change.--The Extension Center may 
                incorporate into instruction and training for 
                collaborating providers activities to improve the 
                culture of safety and foster an ethic of continual 
                improvement among collaborating providers.
                    ``(I) Meetings.--The Extension Center shall provide 
                for meetings of panels of collaborating providers 
                working with Extension Centers on similar quality 
                improvement activities for the purpose of reciprocal 
                learning and information exchange.
                    ``(J) Coordination with other quality improvement 
                entities.--If an Extension Center is not the 
                organization holding a contract under section 1153 of 
                the Social Security Act or a health information 
                technology regional extension center under section 
                3012(c) of the Public Health Service Act, the Extension 
                Center shall cooperate with and avoid duplicating the 
                activities of these entities.
                    ``(K) Other duties.--Such other duties as the 
                Center may specify.
            ``(3) Initial quality improvement activities.--The Center 
        shall immediately prioritize assistance for the implementation 
        of best practices that have been shown to be effective with 
        respect to improvement in the following areas:
                    ``(A) HAI.--Health care-associated infections, 
                including reducing catheter-associated urinary tract 
                infection, ventilator-associated pneumonia, and central 
                line-associated bloodstream infections.
                    ``(B) Surgery.--Hospital and outpatient 
                perioperative care, including reducing surgical-site 
                infections and surgical errors such as wrong-site 
                surgery and retained foreign bodies.
                    ``(C) ER.--Hospital emergency rooms, including the 
                development of comprehensive unit-based safety 
                programs, `handovers' of care when transferring 
                patients from the emergency room to other hospital 
                departments or sites for treatment, early 
                identification and treatment for sepsis, and use of 
                principles of efficiency of design and delivery to 
                improve patient flow.
                    ``(D) Obstetrics.--Obstetrical and neonatal care, 
                including the appropriate use of cesarean sections, and 
                the implementation of best practices for labor and 
                delivery care.
                    ``(E) Care transitions.--Transitions of patients 
                between settings, including reduction of unnecessary 
                hospital readmissions and increased coordination 
                between teams of unaffiliated providers.
    ``(f) Assessment of Effectiveness of Quality Improvement 
Activities.--
            ``(1) Impact statements.--Each Extension Center shall make 
        available to the public and the Center impact statements with 
        respect to its activities to assist health care providers to 
        implement best practices. Such impact statements shall contain 
        de-identified information on progress implementing highly 
        effective practices, the impact of the Extension Center's 
        activities on patient outcomes and satisfaction, including 
        lives saved, and cost savings attributable to the activities of 
        the Extension Center, and shall include such additional 
        information as the Center may specify.
            ``(2) Aggregate impact statement.--The Center shall 
        aggregate the progress reports of the Extension Centers into a 
        national impact statement. The national impact statement shall 
        contain information on the aggregate progress implementing 
        highly effective practices, the aggregate impact of the 
        Extension Centers' activities on patient outcomes and 
        satisfaction, including lives saved, and aggregate cost savings 
        attributable to the activities of the Extension Centers, 
        including cost savings to Medicare and Medicaid, and shall 
        include such additional information as the Center may specify.
            ``(3) Evaluation of effectiveness.--To the extent 
        practicable, the Center shall evaluate the effect of 
        implementing individual best practices on improving patient 
        outcomes and satisfaction.
    ``(g) Health Care Delivery Design.--
            ``(1) In general.--The Center shall conduct or fund 
        activities to develop superior designs for the delivery of 
        health services. This activity may utilize tools such as 
        operations research, systems engineering, rapid design 
        laboratories, cognitive and social psychology studies, 
        materials sciences, and statistics.
            ``(2) Examples of activities to be conducted.--Health care 
        delivery design activities conducted under this paragraph may 
        examine methods to--
                    ``(A) improve the arrangement of surgical suites to 
                facilitate teamwork among physicians, nurses, and other 
                members of the care team;
                    ``(B) increase the likelihood that clinical 
                guidelines are followed in care settings;
                    ``(C) design medication systems to prevent 
                medication errors;
                    ``(D) improve rounding, handoff, and shift changes 
                to improve coordination of patient care;
                    ``(E) develop discharge practices that improve 
                coordination and reduce confusion and duplicative care;
                    ``(F) craft and implement effective patient 
                education procedures; and
                    ``(G) improve the design and protocols of emergency 
                rooms to reduce unsafe conditions and ambulance 
                diversions.
            ``(3) Solicitation of input.--The Center shall solicit 
        input from health care providers on areas in which development 
        of best practices in health care delivery are most needed to 
        improve patient care and satisfaction.
            ``(4) Requirements.--The health care delivery design 
        improvement activities conducted under this paragraph shall--
                    ``(A) be based on identified need for improvement 
                in a specific area of health care delivery;
                    ``(B) aim to discover or develop designs that can 
                be readily adopted by health care providers and 
                facilities;
                    ``(C) aim to improve patient outcomes and 
                satisfaction;
                    ``(D) where applicable, be designed to be 
                consistent with standards adopted by the Director 
                (under section 3004 of the Public Health Service Act) 
                for health information technology used in the 
                collection and reporting of quality information, 
                including for purposes of the demonstration of 
                meaningful use of certified Electronic Medical Record 
                technology by physicians and hospitals under the 
                Medicare program (under sections 1842(o)(2) and 
                1886(n)(3), respectively, of the Social Security Act 
                (42 U.S.C. 1395w-4(o)(2), 1395ww(n)(3))); and
                    ``(E) where applicable, assist health care 
                practitioners in working with other health care 
                practitioners across the continuum of care and in 
                engaging patients and their families in improving the 
                care and patient outcomes.
    ``(h) Research and Related Activities.--The Center shall conduct or 
fund research and other knowledge generation activities on the factors 
that facilitate behavior change for the sustainable integration of 
highly effective and innovative practices into medical practice and on 
the factors that foster an environment of continual improvement.
    ``(i) Public Dissemination of Information.--The Center shall 
provide for the public dissemination of objective information with 
respect to activities and research conducted under this Act. Such 
information shall be made available through multiple media and 
appropriate formats to reflect the varying needs of consumers and 
diverse levels of health literacy.
    ``(j) Reports.--
            ``(1) Annual reports.--Not later than April 1 of each year, 
        beginning in 2011, the Director of the Center shall submit a 
        report to the Secretary on the activities of the Center and the 
        Extension Centers during the preceding year.
            ``(2) Content.--Each report submitted under paragraph (1) 
        shall include information on--
                    ``(A) the number of arrangements established by 
                Extension Centers with collaborating providers;
                    ``(B) the progress made accelerating the 
                implementation of best practices by the collaborating 
                providers during the year involved and for such other 
                years as the Director determines to be appropriate;
                    ``(C) the level of implementation of best practices 
                at collaborating providers as compared to other 
                providers;
                    ``(D) the impact of the work of each Extension 
                Center on patient outcomes and patient safety, 
                including lives saved, and cost savings attributable to 
                the activity or initiatives of the Extension Center;
                    ``(E) the aggregate national impact of the work of 
                the Center and Extension Centers on patient outcomes 
                and patient safety, including lives saved, and cost 
                savings attributable to the activity or initiatives of 
                the Extension Centers and the Center, including cost 
                savings to Medicare and Medicaid;
                    ``(F) progress made toward the national goals for 
                health care quality improvement, as established under 
                secton 941;
                    ``(G) evaluations of the impact of implementing 
                individual best practices on patient outcomes and 
                satisfaction, to the extent such analysis is 
                practicable;
                    ``(H) research and other related activities 
                conducted or funded by the Center during the year 
                involved and the results of those efforts in improving 
                patient safety and the quality of care in the delivery 
                of health care services or in the science of 
                improvement; and
                    ``(I) such other matters as the Center, or the 
                Secretary, determines to be appropriate.
            ``(3) Public availability.--The Secretary shall transmit 
        each report under this subsection to Congress and shall make 
        each such report available to the public.

``SEC. 944. REGIONAL HEALTH EXTENSION CENTERS.

    ``(a) Establishment of Regional Health Extension Centers.--The 
Center shall establish, either directly or through contracts with 
qualified entities (as defined in subsection (b)), Regional Health 
Extension Centers (referred to in this Act as `Extension Centers') to 
carry out the functions described in section 943(e) within such States 
or regions as the Center determines to be appropriate:
    ``(b) Definition.--In this section, the term `qualified entity' 
means an entity that meets all of the following requirements:
            ``(1) Demonstrated experience.--The entity has experience--
                    ``(A) in carrying out the type of functions 
                described in section 942(e);
                    ``(B) in operating programs on a statewide, 
                regionwide, or nationwide basis to improve patient 
                safety and the quality of health care delivered in 
                health care settings; and
                    ``(C) in working with a variety of institutional 
                health care providers, physicians and other health care 
                practitioners.
            ``(2) Nonprofit organization.--The entity is a nonprofit 
        entity organized for charitable purposes under section 501(c) 
        of the Internal Revenue Code of 1986.
            ``(3) Governance.--The entity is governed by a board that 
        includes representatives of multiple health care and nonhealth 
        care stakeholders (including consumers), such that 
        representatives of no single stakeholder group constitute a 
        majority.
            ``(4) Entities with other existing contracts.--The 
        performance of services under this act shall be deemed not to 
        create a conflict of interest under other existing Federal 
        contracts for quality improvement, health information 
        technology technical assistance, or data aggregation.
            ``(5) Audits.--The Extension Centers shall be subject to 
        periodic audit.

``SEC. 945. FUNDING.

    ``For the purpose of carrying out this part, there is authorized to 
be appropriated $200,000,000 for each of the fiscal years 2010 through 
2014.''.
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