I 

111TH CONGRESS 

2D SESSION H. R. 6306 

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

IN THE HOUSE OF REPRESENTATIVES 

SEPTEMBER 29, 2010 

Ms. BALDWIN introduced the following bill; which was referred to the 

Committee on Energy and Commerce 

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 2010’’. 

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 signifi10 cant danger to life, limb, or organ function and reVerDate Mar 15 2010 22:43 Oct 12, 2010 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H6306.IH H6306

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1 quire comprehensive care and constant monitoring, 

2 usually in intensive care units. 

3 (2) Each year, approximately five million Amer4 icans are admitted into traditional, surgical, pedi5 atric, or neo-natal intensive care units. 

6 (3) Nearly 80 percent of all Americans will ex7 perience a critical care injury or illness as a patient, 

8 family member, or friend of a patient. 

9 (4) Critical care medicine consumes a signifi10 cant amount of financial resources, accounting for 

11 more than 13 percent of all hospital costs. 

12 (5) According to a 2006 report by the Health 

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

14 demand in the United States for critical care med15 ical services is on the rise, due in part to the grow16 ing elderly population, as individuals over the age of 

17 65 consume a large percentage of critical care serv18 ices. 

19 (6) The HRSA report also found that the grow20 ing aging population will further exacerbate an exist21 ing shortage of intensivists, the physicians certified 

22 in critical care who primarily deliver care in inten23 sive care units, potentially compromising the quality 

24 and availability of care. 


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1 (7) The demand on critical services and trained 

2 personnel increases exponentially in the event of a 

3 natural disaster or pandemic outbreak such as the 

4 H1N1 virus. 

5 (8) Ensuring the strength of our critical care 

6 medical delivery infrastructure is integral to the im7 provement of the quality and delivery of health care 

8 in the United States. 

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

10 the current state of the United States critical care medical 

11 delivery system and implement policies to improve the 

12 quality and effectiveness of care delivered to the critically 

13 ill and injured. 

14 SEC. 3. STUDIES ON CRITICAL CARE. 

15 (a) INSTITUTE OF MEDICINE STUDY.— 

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

17 Human Services (in this Act referred to as the ‘‘Sec18 retary’’) shall enter into an agreement with the In19 stitute of Medicine under which, not later than 1 

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

21 Institute will— 

22 (A) conduct an analysis of the current 

23 state of critical care health services in the 

24 United States; 


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1 (B) develop recommendations to bolster 

2 critical care capabilities to meet future demand; 

3 and 

4 (C) submit to Congress a report including 

5 the analysis and recommendations under sub6 paragraphs (A) and (B). 

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

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

9 for the following: 

10 (A) Analysis of the current critical care 

11 system in the United States, including— 

12 (i) the system’s capacity and re13 sources, including the size of the critical 

14 care workforce and the availability of 

15 health information technology and medical 

16 equipment; 

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

18 and future challenges; and 

19 (iii) the system’s ability to provide 

20 adequate care for the critically ill or in21 jured in response to a national health 

22 emergency, including a pandemic or nat23 ural disaster. 

24 (B) Analysis and recommendations regard25 ing regionalizing critical care systems. 


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1 (C) Analysis regarding the status of crit2 ical care research in the United States and rec3 ommendations for future research priorities. 

4 (b) GOVERNMENT ACCOUNTABILITY OFFICE

5 STUDY.—Not later than 1 year after the date of the enact6 ment of this Act, the Comptroller General of the United 

7 States shall issue a report including the following: 

8 (1) An inventory of all current and recent crit9 ical care research and critical care-related programs 

10 of the Federal Government and recommendations on 

11 how to better coordinate critical care research ef12 forts. 

13 (2) An economic analysis of critical care costs 

14 as a percentage of overall Federal health care spend15 ing, and a comparison of such percentage to the per16 centage of Federal critical research expenditures rel17 ative to overall Federal health research spending. 

18 (c) HEALTH RESOURCES AND SERVICES ADMINIS19 TRATION STUDY.— 

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

21 through the Administrator of the Health Resources 

22 and Services Administration, shall review and update 

23 the Administration’s 2006 study entitled ‘‘The Crit24 ical Care Workforce: A Study of the Supply and De25 mand for Critical Care Physicians’’. 


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

2 Secretary shall expand the scope of the study to ad3 dress the supply and demand of other providers 

4 within the spectrum of critical care delivery, includ5 ing critical care nurses, mid-level providers (such as 

6 physician assistants and nurse practitioners), inten7 sive care unit pharmacists, and intensive care unit 

8 respiratory care practitioners. 

9 SEC. 4. NIH CRITICAL CARE COORDINATING COUNCIL. 

10 (a) ESTABLISHMENT.—The Secretary, acting 

11 through the Director of the National Institutes of Health, 

12 shall establish a council within the Institutes to be known 

13 as the Critical Care Coordinating Council (in this section 

14 referred to as the ‘‘Council’’). 

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

16 the membership of the Council includes representatives of 

17 each of— 

18 (1) the National Heart, Lung, and Blood Insti19 tute; 

20 (2) the National Institute of Nursing Research; 

21 (3) the Eunice Kennedy Shriver National Insti22 tute of Child Health and Human Development; and 

23 (4) any other national research institute or na24 tional center of the National Institutes of Health 

25 that Secretary deems appropriate. 


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1 (c) DUTIES.—The Council shall— 

2 (1) coordinate the collection and analysis of in3 formation on current research of the National Insti4 tutes of Health relating to the care of the critically 

5 ill and injured, identify gaps in such research, and 

6 make recommendations to the Director of such Insti7 tutes on how to improve such research; and 

8 (2) provide annual reports to the Director re9 garding research efforts of the National Institutes of 

10 Health relating to the care of the critically ill and 

11 injured, and make recommendations in such reports 

12 on how to strengthen partnerships within the Na13 tional Institutes of Health and between the National 

14 Institutes of Health and public and private entities 

15 to expand collaborative, cross-cutting research. 

16 SEC. 5. IMPROVING FEDERAL DISASTER PREPAREDNESS 

17 EFFORTS TO CARE FOR THE CRITICALLY ILL 

18 AND INJURED. 

19 (a) REPORT ON AVAILABILITY OF CRITICAL CARE

20 PRACTITIONERS.—Not later than 1 year after the date of 

21 the enactment of this Act, the Secretary shall submit a 

22 report to the Congress on the adequacy of the number of 

23 critical care practitioners in disaster medical assistance 

24 teams, the Medical Reserve Corps, and the Public Health 

25 Service Commissioned Corps. Such report shall include 


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1 recommendations, as necessary, for addressing any short2 ages in the number of such practitioners. 

3 (b) RECOMMENDATIONS FOR EMERGENCY ICU 

4 EVACUATION PRACTICES.—Not later than 1 year after the 

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

6 through the Director of the Agency for Healthcare Re7 search and Quality, in consultation with critical care prac8 titioners, shall develop guidelines or best practices for the 

9 evacuation of intensive care units during a national health 

10 emergency, including a pandemic or natural disaster. 

11 (c) PANEL ON EMERGENCY PREPAREDNESS DATA12 BASES.— 

13 (1) ESTABLISHMENT.—The Secretary shall es14 tablish a panel of emergency preparedness experts to 

15 be known as the Panel on Emergency Preparedness 

16 Databases (in this section referred to as the 

17 ‘‘Panel’’). 

18 (2) MEMBERSHIP.—The Secretary shall ensure 

19 that the membership of the Panel includes experts 

20 from the public and private sector and experts from 

21 the critical care community. 

22 (3) DUTIES.—The Panel shall— 

23 (A) assess the adequacy of existing na24 tional preparedness databases in facilitating ef25 fective and coordinated local, State, and FedVerDate Mar 15 2010 22:43 Oct 12, 2010 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H6306.IH H6306

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1 eral medical responses during a national health 

2 emergency, including a pandemic or natural dis3 aster; 

4 (B) identify gaps in existing information 

5 networks; 

6 (C) recommend specific ways to improve 

7 awareness of the availability of resources before, 

8 during, and after an incident; and 

9 (D) submit to the Director of the National 

10 Institutes of Health a report including the as11 sessment, identification, and recommendations 

12 made under subparagraphs (A) through (C), re13 spectively. 

Æ 


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