I 

113TH CONGRESS 

1ST SESSION H. R. 2651 

To improve the understanding and coordination of critical care health services. 

IN THE HOUSE OF REPRESENTATIVES 

JULY 10, 2013 

Mr. PAULSEN (for himself, Mr. MATHESON, and Mr. RUPPERSBERGER) introduced the following bill; which was referred to the Committee on Energy 

and Commerce, and in addition to the Committee on Ways and Means, 

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 improve the understanding and coordination of critical 

care health services. 

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 ‘‘Critical Care Assess5 ment and Improvement Act of 2013’’. 

6 SEC. 2. FINDINGS; PURPOSES. 

7 (a) FINDINGS.—Congress finds the following: 

8 (1) Critical care medicine is the care for pa9 tients whose illnesses or injuries present a signifiVerDate Mar 15 2010 03:22 Jul 11, 2013 Jkt 029200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H2651.IH H2651

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1 cant danger to life, limb, or organ function and re2 quire comprehensive care and constant monitoring, 

3 usually in intensive care units (ICUs). 

4 (2) Each year, approximately five million Amer5 icans are admitted into adult medical, surgical, pedi6 atric, or neonatal ICUs. 

7 (3) Critical care medicine encompasses a wide 

8 array of diseases and health issues. The care pro9 vided in the ICU is highly specialized and complex 

10 due to the extreme severity of illness of its patient 

11 population, often involving multiple disease processes 

12 in different organ systems at the same time. 

13 (4) Critical care medicine consumes a signifi14 cant amount of financial resources, accounting for 

15 more than 17 percent of all hospital costs. 

16 (5) According to a recent study published in the 

17 Journal of Critical Care Medicine, despite the fact 

18 that cancer care and critical care place similar eco19 nomic burdens on society, proportionally 3.1 to 11.4 

20 times more research money was spent on cancer care 

21 research than critical care research. 

22 (6) According to a 2006 report by the Health 

23 Resources and Services Administration (‘‘HRSA’’), 

24 demand in the United States for critical care med25 ical services is on the rise, due in part to the growVerDate Mar 15 2010 03:22 Jul 11, 2013 Jkt 029200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H2651.IH H2651

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1 ing elderly population, as individuals over the age of 

2 65 consume a large percentage of critical care serv3 ices. 

4 (7) The HRSA report also found that the grow5 ing aging population will further exacerbate an exist6 ing shortage of intensivists, the physicians certified 

7 in critical care who primarily deliver care in inten8 sive care units, potentially compromising the quality 

9 and availability of care. Today, intensivist-led teams 

10 treat only one-third of critically ill patients despite 

11 substantial evidence that these teams lead to im12 proved outcomes. 

13 (8) Ensuring the strength of our critical care 

14 medical delivery infrastructure is integral to the im15 provement of the quality and delivery of health care 

16 in the United States. 

17 (b) PURPOSE.—The purpose of this Act is to assess 

18 the current state of the United States critical care medical 

19 delivery system and implement policies to improve the 

20 quality and effectiveness of care delivered to the critically 

21 ill and injured. 

22 SEC. 3. STUDIES ON CRITICAL CARE. 

23 (a) INSTITUTE OF MEDICINE STUDY.— 

24 (1) IN GENERAL.—The Secretary of Health and 

25 Human Services (in this Act referred to as the ‘‘SecVerDate Mar 15 2010 03:22 Jul 11, 2013 Jkt 029200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H2651.IH H2651

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1 retary’’) shall enter into an agreement with the In2 stitute of Medicine under which, not later than 1 

3 year after the date of the enactment of this Act, the 

4 Institute will— 

5 (A) conduct an analysis of the current 

6 state of critical care health services in the 

7 United States; 

8 (B) develop recommendations to bolster 

9 critical care capabilities to meet future demand; 

10 and 

11 (C) submit to Congress a report including 

12 the analysis and recommendations under sub13 paragraphs (A) and (B). 

14 (2) ISSUES TO BE STUDIED.—The agreement 

15 under paragraph (1) shall, at a minimum, provide 

16 for the following: 

17 (A) Analysis of the current critical care 

18 system in the United States, including— 

19 (i) the system’s capacity and re20 sources, including the size of the critical 

21 care workforce and the availability of 

22 health information technology and medical 

23 equipment; 

24 (ii) the system’s strengths, limitations, 

25 and future challenges; and 


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1 (iii) the system’s ability to provide 

2 adequate care for the critically ill or in3 jured in response to a national health 

4 emergency, including a pandemic or nat5 ural disaster. 

6 (B) Analysis and recommendations regard7 ing regionalizing critical care systems. 

8 (C) Analysis regarding the status of crit9 ical care research in the United States and rec10 ommendations for future research priorities. 

11 (b) HEALTH RESOURCES AND SERVICES ADMINIS12 TRATION STUDY.— 

13 (1) IN GENERAL.—The Secretary, acting 

14 through the Administrator of the Health Resources 

15 and Services Administration, shall review and update 

16 the Administration’s 2006 study entitled ‘‘The Crit17 ical Care Workforce: A Study of the Supply and De18 mand for Critical Care Physicians’’. 

19 (2) SCOPE.—In carrying out paragraph (1), the 

20 Secretary shall expand the scope of the study to ad21 dress the supply and demand of other providers 

22 within the spectrum of critical care delivery, includ23 ing critical care nurses, mid-level providers (such as 

24 physician assistants and nurse practitioners), intenVerDate Mar 15 2010 03:22 Jul 11, 2013 Jkt 029200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H2651.IH H2651

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1 sive care unit pharmacists, and intensive care unit 

2 respiratory care practitioners. 

3 SEC. 4. NIH CRITICAL CARE COORDINATING COUNCIL. 

4 (a) ESTABLISHMENT.—The Secretary, acting 

5 through the Director of the National Institutes of Health, 

6 shall establish a council within the Institutes to be known 

7 as the Critical Care Coordinating Council (in this section 

8 referred to as the ‘‘Council’’). 

9 (b) MEMBERSHIP.—The Secretary shall ensure that 

10 the membership of the Council includes representatives of 

11 each of— 

12 (1) the National Heart, Lung, and Blood Insti13 tute; 

14 (2) the National Institute of Nursing Research; 

15 (3) the Eunice Kennedy Shriver National Insti16 tute of Child Health and Human Development; 

17 (4) the National Institute of General Medical 

18 Sciences; 

19 (5) the National Institute on Aging; and 

20 (6) any other national research institute or na21 tional center of the National Institutes of Health 

22 that the Secretary deems appropriate. 

23 (c) DUTIES.—The Council shall— 

24 (1) serve as the focal point and catalyst across 

25 the National Institutes of Health for advancing reVerDate Mar 15 2010 21:27 Jul 11, 2013 Jkt 029200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H2651.IH H2651

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1 search and research training in the critical care set2 ting; 

3 (2) coordinate funding opportunities that in4 volve multiple national research institutes or na5 tional centers of the National Institutes of Health; 

6 (3) catalyze the development of new funding op7 portunities; 

8 (4) inform investigators about funding opportu9 nities in their areas of interest; 

10 (5) represent the National Institutes of Health 

11 in Government-wide efforts to improve the Nation’s 

12 critical care system; 

13 (6) coordinate the collection and analysis of in14 formation on current research of the National Insti15 tutes of Health relating to the care of the critically 

16 ill and injured and identify gaps in such research; 

17 (7) provide an annual report to the Director on 

18 the National Institutes of Health regarding research 

19 efforts of the Institutes relating to the care of the 

20 critically ill and injured; and 

21 (8) make recommendations in each such report 

22 on how to strengthen partnerships within the Na23 tional Institutes of Health and between the Insti24 tutes and public and private entities to expand col25 laborative, cross-cutting research. 


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1 SEC. 5. CENTERS FOR MEDICARE AND MEDICAID INNOVA2 TION CRITICAL CARE DEMONSTRATION 

3 PROJECT. 

4 (a) IN GENERAL.—Not later than one year after the 

5 date of the enactment of this Act, the Secretary, acting 

6 through the Center for Medicare and Medicaid Innovation 

7 created under section 1115A of the Social Security Act 

8 (42 U.S.C. 1315a), shall carry out a demonstration 

9 project designed to improve the quality and efficiency of 

10 care provided to critically ill and injured patients receiving 

11 critical care in intensive care units or other areas of acute 

12 care hospitals. 

13 (b) ACTIVITIES UNDER DEMONSTRATION

14 PROJECT.—The activities conducted under the 

15 demonstration project under subsection (a) may, in addi16 tion to any other activity specified by the Center for Medi17 care and Medicaid Innovation, include activities that seek 

18 to— 

19 (1) improve the coordination and transitions of 

20 care to and from an intensive care unit and the next 

21 point of care; 

22 (2) incorporate value-based purchasing meth23 odologies; or novel informatics, monitoring or other 

24 methodologies to eliminate error, improve outcomes, 

25 and reduce waste from the delivery of critical care; 


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1 (3) improve prediction models that help health 

2 care providers and hospitals identify patients at high 

3 risk for requiring critical care services and stream4 line care delivery to prevent unexpected hospital re5 admissions for critical illnesses; and 

6 (4) utilize bundled payment approaches and in7 centive care redesign, such as efforts to facilitate 

8 and support comprehensive team delivered care. 

Æ 


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