[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[S. 2966 Introduced in Senate (IS)]
113th CONGRESS
2d Session
S. 2966
To improve the understanding and coordination of critical care health
services.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
November 20, 2014
Ms. Baldwin (for herself and Mr. Portman) introduced the following
bill; which was read twice and referred to the Committee on Finance
_______________________________________________________________________
A BILL
To improve the understanding and coordination of critical care health
services.
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 ``Critical Care Assessment and
Improvement Act of 2014''.
SEC. 2. FINDINGS; PURPOSES.
(a) Findings.--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) Purpose.--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.
SEC. 3. STUDIES ON CRITICAL CARE.
(a) Institute of Medicine Study.--
(1) In general.--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) Issues to be studied.--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) In general.--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) Scope.--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.
SEC. 4. NIH CRITICAL CARE COORDINATING WORKING GROUP.
(a) Establishment.--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) Membership.--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) Duties.--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.
SEC. 5. CENTERS FOR MEDICARE AND MEDICAID INNOVATION CRITICAL CARE
DEMONSTRATION PROJECT.
(a) In General.--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.
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