I 

111TH CONGRESS 

1ST SESSION H. R. 1581 

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

care workforce. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 18, 2009 

Ms. SCHAKOWSKY (for herself and Mr. CANTOR) introduced the following bill; 

which was referred to the Committee on Energy and Commerce, and in 

addition to the Committee on Agriculture, for a period to be subsequently 

determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned 

A BILL 

To optimize the delivery of critical care medicine and expand 

the critical care workforce. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Patient-Focused Crit5 ical Care Enhancement Act’’. 

6 SEC. 2. PURPOSE. 

7 The purpose of this Act is to optimize the delivery 

8 of critical care medicine and expand the critical care work9 force. 


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1 SEC. 3. FINDINGS. 

2 Based on the Health Resources and Services Admin3 istration’s May 2006 Report to Congress, The Critical 

4 Care Workforce: A Study of the Supply and Demand for 

5 Critical Care Physicians, the Congress makes the fol6 lowing findings: 

7 (1) In 2000, an estimated 18,000,000 inpatient 

8 days of ICU care were provided in the United States 

9 through approximately 59,000 ICU beds in 3,200 

10 hospitals. 

11 (2) Patient outcomes and the quality of care in 

12 the ICU are related to who delivers that care and 

13 how care is organized. 

14 (3) The demand in the United States for crit15 ical care medical services is rising sharply and will 

16 continue to rise sharply largely as a result of the fol17 lowing 3 factors: 

18 (A) There is strong evidence dem19 onstrating improvements in outcomes and effi20 ciency when intensive care services are provided 

21 by nurses and intensivist physicians who have 

22 advanced specialty training in critical care med23 icine. 

24 (B) The Leapfrog Group, health care 

25 payors, and providers are encouraging greater 

26 use of such personnel in intensive care settings. 


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1 (C) Critical care services are overwhelm2 ingly consumed by patients over the age of 65 

3 and the aging of the United States population 

4 is driving demand for these services. 

5 (4) The future growth in the number of critical 

6 care physicians in ICU settings will be insufficient 

7 to keep pace with growing demand. 

8 (5) This growing shortage of critical care physi9 cians presents a serious threat to the quality and 

10 availability of health care services in the United 

11 States. 

12 (6) This shortage will disproportionately impact 

13 rural and other areas of the United States that al14 ready often suffer from a suboptimal level of critical 

15 care services. 

16 SEC. 4. RESEARCH. 

17 (a) IN GENERAL.—The Secretary of Health and 

18 Human Services, through the Agency for Healthcare Re19 search and Quality, shall conduct research to assess— 

20 (1) the standardization of critical care proto21 cols, intensive care unit layout, equipment interoper22 ability, and medical informatics; 

23 (2) the impact of differences in staffing, organi24 zation, size, and structure of intensive care units on 

25 access, quality, and efficiency of care; and 


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1 (3) coordinated community and regional ap2 proaches to providing critical care services, including 

3 approaches whereby critical care patients are as4 sessed and provided care based upon intensity of 

5 services required. 

6 (b) REPORT.—Not later than 18 months after the 

7 date of enactment of this Act, the Agency for Healthcare 

8 Research and Quality shall submit a report to Congress, 

9 that, based on the review under subsection (a), evaluates 

10 and makes recommendations regarding best practices in 

11 critical care medicine. 

12 SEC. 5. INNOVATIVE APPROACHES TO CRITICAL CARE 

13 SERVICES. 

14 The Secretary of Health and Human Services shall 

15 undertake the following demonstration projects: 

16 (1) OPTIMIZATION OF CRITICAL CARE SERV17 ICES.— 

18 (A) IN GENERAL.—The Administrator of 

19 the Centers for Medicare & Medicaid Services 

20 shall solicit proposals submitted by inpatient 

21 providers of critical care services who propose 

22 to demonstrate methods to optimize the provi23 sion of critical care services to Medicare bene24 ficiaries through innovations in such areas as 


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1 staffing, ICU arrangement, and utilization of 

2 technology. 

3 (B) FUNDING OF PROPOSALS.—The Ad4 ministrator of the Centers for Medicare & Med5 icaid Services shall fund not more than 5 pro6 posals, not less than 1 of which shall focus on 

7 the training of hospital-based physicians in 

8 rural or community, or both, hospital facilities 

9 in the provision of critical care medicine. Such 

10 projects shall emphasize outcome measures 

11 based on the Institute of Medicine’s following 6 

12 domains of quality care: 

13 (i) Care should be safe. 

14 (ii) Care should be effective. 

15 (iii) Care should be patient-centered. 

16 (iv) Care should be timely. 

17 (v) Care should be efficient. 

18 (vi) Care should be equitable. 

19 (2) FAMILY ASSISTANCE PROGRAMS FOR THE

20 CRITICALLY ILL.— 

21 (A) IN GENERAL.—The Secretary of 

22 Health and Human Services shall solicit pro23 posals and make an award to support a consor24 tium consisting of 1 or more providers of inpa25 tient critical care services and a medical speVerDate Nov 24 2008 06:55 Mar 19, 2009 Jkt 079200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H1581.IH H1581

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1 cialty society involved in the education and 

2 training of critical care providers. 

3 (B) MEASUREMENT AND EVALUATION.—A 

4 provider that receives support under subpara5 graph (A) shall measure and evaluate outcomes 

6 derived from a ‘‘family-centered’’ approach to 

7 the provision of inpatient critical care services 

8 that includes direct and sustained communica9 tion and contact with beneficiary family mem10 bers, involvement of family members in the crit11 ical care decisionmaking process, and respon12 siveness of critical care providers to family re13 quests. Such project shall evaluate the impact 

14 of a family-centered, multiprofessional team ap15 proach on, and the correlation between— 

16 (i) family satisfaction; 

17 (ii) staff satisfaction; 

18 (iii) length of patient stay in an inten19 sive care unit; and 

20 (iv) cost of care. 

21 (C) OUTCOME MEASURES.—A provider 

22 that receives support under subparagraph (A) 

23 shall emphasize outcome measures based on the 

24 Institute of Medicine’s following 6 domains of 

25 quality care: 


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1 (i) Care should be safe. 

2 (ii) Care should be effective. 

3 (iii) Care should be patient-centered. 

4 (iv) Care should be timely. 

5 (v) Care should be efficient. 

6 (vi) Care should be equitable. 

7 SEC. 6. USE OF TELEMEDICINE TO ENHANCE CRITICAL 

8 CARE SERVICES IN RURAL AREAS. 

9 (a) AMENDMENT TO RURAL UTILITIES SERVICE DIS10 TANCE LEARNING AND TELEMEDICINE PROGRAM.— 

11 Chapter 1 of subtitle D of title XXIII of the Food, Agri12 culture, Conservation, and Trade Act of 1990 (7 U.S.C. 

13 950aaa et seq.) is amended by adding at the end the fol14 lowing: 

15 ‘‘SEC. 2335B. ADDITIONAL AUTHORIZATION OF APPROPRIA16 TIONS FOR TELEMEDICINE CRITICAL CARE 

17 INITIATIVES. 

18 ‘‘In addition to amounts authorized under section 

19 2335A, there is authorized to be appropriated $5,000,000 

20 in each of fiscal years 2010 through 2012 to carry out 

21 telemedicine initiatives under this chapter whereby 1 or 

22 more rural providers of inpatient critical care services pro23 pose, through collaboration with other providers, to aug24 ment the delivery of critical care services in the rural inpa25 tient setting through the use of telecommunications sysVerDate Nov 24 2008 06:55 Mar 19, 2009 Jkt 079200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H1581.IH H1581

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1 tems that allow for consultation with critical care pro2 viders not located in the rural facility regarding the care 

3 of such patients.’’. 

4 (b) AMENDMENT TO TELEHEALTH NETWORK GRANT

5 PROGRAM.—Section 330I(i)(1)(B) of the Public Health 

6 Service Act (42 U.S.C. 254c–14(i)(1)(B)) is amended by 

7 striking the period at the end and inserting ‘‘, or that aug8 ment the delivery of critical care services in rural inpatient 

9 settings through consultation with providers located else10 where.’’. 

11 SEC. 7. INCREASING THE SUPPLY OF CRITICAL CARE PRO12 VIDERS. 

13 Section 338B of the Public Health Service Act (42 

14 U.S.C. 254l–1) is amended by adding at the end the fol15 lowing: 

16 ‘‘(i) CRITICAL CARE INITIATIVE.— 

17 ‘‘(1) ESTABLISHMENT.—The Secretary shall 

18 undertake an initiative that has as its goal the an19 nual recruitment of not less than 50 providers of 

20 critical care services into the National Health Serv21 ice Corps Loan Repayment Program. Providers re22 cruited pursuant to this initiative shall be additional 

23 to, and not detract from, existing recruitment activi24 ties otherwise authorized by this section. 


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1 ‘‘(2) CLARIFYING AMENDMENT.—The initiative 

2 described in paragraph (1) shall be undertaken pur3 suant to the authority of this section, and for pur4 poses of the initiative— 

5 ‘‘(A) the term ‘primary health services’ as 

6 used in subsection (a) shall be understood to in7 clude critical care services; and 

8 ‘‘(B) the term ‘an approved graduate 

9 training program’ as used in subsection 

10 (b)(1)(B) shall be limited to pulmonary fellow11 ships or critical care fellowships, or both, for 

12 physicians.’’. 

13 SEC. 8. AUTHORIZATION OF APPROPRIATIONS. 

14 There are authorized to be appropriated to carry out 

15 this Act— 

16 (1) $5,000,000 for the research to be conducted 

17 under section 4; and 

18 (2) $4,000,000 for the demonstration projects 

19 authorized under section 5. 

Æ 


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