[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[S. 1020 Introduced in Senate (IS)]

111th CONGRESS
  1st Session
                                S. 1020

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


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                              May 12, 2009

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 Pensions

_______________________________________________________________________

                                 A BILL


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

    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 ``Patient-Focused Critical Care 
Enhancement Act''.

SEC. 2. PURPOSE.

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

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:
            (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.

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--
            (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) 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.

SEC. 5. INNOVATIVE APPROACHES TO CRITICAL CARE SERVICES.

    The Secretary of Health and Human Services shall undertake the 
following demonstration projects:
            (1) Optimization of critical care services.--
                    (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.
                    (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:
                            (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) 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.
                    (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--
                            (i) family satisfaction;
                            (ii) staff satisfaction;
                            (iii) length of patient stay in an 
                        intensive care unit; and
                            (iv) cost of care.
                    (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:
                            (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.

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:

``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.''.
    (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.''.

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:
    ``(i) Critical Care Initiative.--
            ``(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.
            ``(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--
                    ``(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.''.

SEC. 8. AUTHORIZATION OF APPROPRIATIONS.

    There 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.
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