[Congressional Record Volume 153, Number 34 (Wednesday, February 28, 2007)]
[Senate]
[Pages S2370-S2371]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. DURBIN (for himself and Mr. Crapo):
  S. 718. A bill to optimize the delivery of critical care medicine and 
expand the critical care workforce; to the Committee on Health, 
Education, Labor, and Pensions.
  Mr. DURBIN. Mr. President, why hold off for tomorrow what we can do 
today? The current healthcare crisis in our Nation did not happen 
overnight. It has been accumulating as a result of a lack of serious 
attention to the most pressing healthcare issues, including healthcare 
workforce shortages. As a husband and a parent, I pray every day that 
my wife and children will have access to the quality healthcare they 
deserve when they need it. As a public official, I believe that it is 
my responsibility to help make that care available for not only my own 
family, but also for the families in the State of Illinois and across 
the Nation.
  The growing shortage of critical care physicians undermines the 
quality and availability of health care services in the United States. 
This shortage can be expected to disproportionately impact rural and 
other areas of the United States that already often suffer from a sub-
optimal level of critical care services. When a loved one needs a 
critical care doctor, would we not want one to be available? If 
research tells us that their recovery may be better and their recovery 
time faster, would we not want our loved one to have access to a 
critical care doctor?
  The Leap Frog Group has clearly documented that significant 
improvement in outcomes--in both quality and cost--result when a 
critically ill or injured patient is seen by an intensivist. With a 
greater use of intensivists, an estimated 54,000 deaths that currently 
occur in ICUs could be avoided. Unfortunately, only one-third of our 
critically ill citizens are treated by physicians and nurses 
specifically trained to manage their complex health issues.
  In June 2003, Congress asked the Health Resources and Services 
Administration--HRSA--to examine the healthcare needs of a growing 
population and the availability of pulmonary and critical care 
physicians. In its May 2006 report to Congress entitled ``The Critical 
Care Workforce: A Study of the Supply and Demand for Critical Care 
Physicians,'' HRSA found that the country does not have enough 
physicians trained in critical care medicine to treat all those in need 
of the care. The report projected future demand for these services and 
found that, as a result of having to staff ICUs with critical care 
doctors, a total of 4,300 intensivist physicians will be needed when 
only 2,800 are available. The HRSA report recognized that the demand in 
the United States for critical care medical services is rising sharply 
and will continue to do so.
  To proactively address the healthcare needs of our nation, I am 
pleased to join with my colleague Senator Crapo today to introduce 
legislation to address the looming shortage of critical care providers. 
Our bill, The Patient-Focused Critical Care Enhancement Act authorizes 
a series of modest and sensible measures that--if enacted now instead 
of waiting for this shortage to worsen--can help to obviate the 
problem.
  First, the Patient-Focused Critical Care Enhancement Act would direct 
the Agency for Health Research and Quality to assess the current state 
of and recommend ``best practices'' for critical care medicine. The 
authorization of demonstration projects on innovations in ICU services 
and on family-centered, multi-disciplinary approaches to critical care 
services are important for determining how to improve the quality of 
the care delivered and how to best make use of our existing resources 
of critical care doctors.
  Our bill would also expand telemedicine opportunities for critical 
care physicians to promote efforts relating to critical care and ensure 
that all communities have greater access to this important, lifesaving 
care. For our rural communities and medically underserved areas, the 
need for critical care doctors is exacerbated. This bill will hopefully 
expand the effectiveness of existing critical care providers in 
environments where intensivists are in short supply.
  Finally, to address the supply problem, the bill would allow for the 
National Health Service Corps to support and encourage critical care 
providers to practice in medically underserved areas.
  The Patient-Focused Critical Care Enhancement Act is strongly 
endorsed by the key medical specialty societies and patient groups 
involved in critical care medicine, including the American College of 
Chest Physicians, the American Thoracic Society, the Society for 
Critical Care Medicine, the Association of Critical Care Nurses and the 
Acute Respiratory Distress Syndrome Foundation.
  This multipronged approach is to look at both short term and long 
term solutions to a growing concern. But in today's complex healthcare 
situation, multiple solutions are a necessity. We do not want to face 
this shortage in the future in a direr situation as the nursing 
shortage currently is.
  The answer to the opening question is simple. We must not hold off 
for tomorrow what we can do today, and we must not wait for our 
healthcare crisis to worsen. Our country will face a critical care 
workforce shortage. I want my family to have access to the best quality 
care when they need it, and this includes having access to a critical 
care doctor. Passage of the Patient-Focused Critical Care Enhancement 
Act is a step in that direction.
  Mr. President, I ask unanimous consent that the text of the bill be 
printed in the Record.
  There being no objection, the text of the bill was ordered to be 
printed in the Record, as follows:

                                 S. 718

       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, 
     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.

     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 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.--

[[Page S2371]]

       (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 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 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 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 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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