II 

111TH CONGRESS 

1ST SESSION S. 1020 

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

care workforce. 

IN THE SENATE OF THE UNITED STATES 

MAY 12, 2009 

Mr. WHITEHOUSE (for himself, Mr. CRAPO, and Mr. GRAHAM) introduced the 

following bill; which was read twice and referred to the Committee on 

Health, Education, Labor, and Pensions 

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. 


jbell on PROD1PC69 with BILLS
2 

•S 1020 IS

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, Congress makes the following 

6 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. 


jbell on PROD1PC69 with BILLS
3 

•S 1020 IS

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 


jbell on PROD1PC69 with BILLS
4 

•S 1020 IS

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 Director of the Agency 

8 for Healthcare Research and Quality shall submit a report 

9 to Congress, that, based on the review under subsection 

10 (a), evaluates and makes recommendations regarding best 

11 practices in 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 


jbell on PROD1PC69 with BILLS
5 

•S 1020 IS

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 01:29 May 13, 2009 Jkt 079200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S1020.IH S1020

jbell on PROD1PC69 with BILLS
6 

•S 1020 IS

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: 


jbell on PROD1PC69 with BILLS
7 

•S 1020 IS

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 AND UNDER9 SERVED AREAS. 

10 (a) AMENDMENT TO RURAL UTILITIES SERVICE DIS11 TANCE LEARNING AND TELEMEDICINE PROGRAM.— 

12 Chapter 1 of subtitle D of title XXIII of the Food, Agri13 culture, Conservation, and Trade Act of 1990 (7 U.S.C. 

14 950aaa et seq.) is amended by adding at the end the fol15 lowing: 

16 ‘‘SEC. 2335B. ADDITIONAL AUTHORIZATION OF APPROPRIA17 TIONS FOR TELEMEDICINE CRITICAL CARE 

18 INITIATIVES. 

19 ‘‘In addition to amounts authorized under section 

20 2335A, there is authorized to be appropriated $5,000,000 

21 in each of fiscal years 2010 through 2015 to carry out 

22 telemedicine initiatives under this chapter whereby 1 or 

23 more providers of inpatient critical care services in rural 

24 or other medically underserved areas propose, through col25 laboration with other providers, to augment the delivery 


jbell on PROD1PC69 with BILLS
8 

•S 1020 IS

1 of critical care services in the rural or other medically un2 derserved area inpatient setting through the use of tele3 communications systems that allow for consultation with 

4 critical care providers not located in the rural or other 

5 medically underserved area facility regarding the care of 

6 such patients.’’. 

7 (b) AMENDMENT TO TELEHEALTH NETWORK GRANT

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

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

10 striking the period at the end and inserting ‘‘, or that aug11 ment the delivery of critical care services in rural or other 

12 medically underserved area inpatient settings through con13 sultation with providers located elsewhere.’’. 

14 SEC. 7. INCREASING THE SUPPLY OF CRITICAL CARE PRO15 VIDERS. 

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

17 U.S.C. 254l–1) is amended by adding at the end the fol18 lowing: 

19 ‘‘(i) CRITICAL CARE INITIATIVE.— 

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

21 undertake an initiative that has as its goal the an22 nual recruitment of not less than 50 providers of 

23 critical care services into the National Health Serv24 ice Corps Loan Repayment Program. Providers re25 cruited pursuant to this initiative shall be additional 


jbell on PROD1PC69 with BILLS
9 

•S 1020 IS

1 to, and not detract from, existing recruitment activi2 ties otherwise authorized by this section. 

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

4 described in paragraph (1) shall be undertaken pur5 suant to the authority of this section, and for pur6 poses of the initiative— 

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

8 used in subsection (a) shall be understood to in9 clude critical care services; and 

10 ‘‘(B) ‘an approved graduate training pro11 gram’ as that term is used in subsection 

12 (b)(1)(B) shall be limited to pulmonary fellow13 ships or critical care fellowships, or both, for 

14 physicians.’’. 

15 SEC. 8. AUTHORIZATION OF APPROPRIATIONS. 

16 There are authorized to be appropriated to carry out 

17 this Act— 

18 (1) $5,000,000 for the research to be conducted 

19 under section 4; and 

20 (2) $4,000,000 for the demonstration projects 

21 authorized under section 5. 

Æ 


jbell on PROD1PC69 with BILLS