II 

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. 

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 2014’’. 

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 Sep 11 2014 23:36 Nov 24, 2014 Jkt 049200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S2966.IS S2966

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1 quire comprehensive care and constant monitoring, 

2 usually in intensive care units (ICUs). 

3 (2) Each year, approximately 5,000,000 people 

4 in the United States are admitted into adult med5 ical, surgical, pediatric, or neonatal ICUs. 

6 (3) Critical care medicine encompasses a wide 

7 array of diseases and health issues. The care pro8 vided in the ICU is highly specialized and complex 

9 due to the extreme severity of illness of its patient 

10 population, often involving multiple disease processes 

11 in different organ systems at the same time. 

12 (4) Critical care medicine consumes a signifi13 cant amount of financial resources, accounting for 

14 more than 17 percent of all hospital costs. 

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

16 Resources and Services Administration (referred to 

17 in this section as ‘‘HRSA’’), demand in the United 

18 States for critical care medical services is on the 

19 rise, due in part to the growing elderly population, 

20 as individuals over the age of 65 consume a large 

21 percentage of critical care services. 

22 (6) The HRSA report also found that the grow23 ing aging population will further exacerbate an exist24 ing shortage of intensivists, the physicians certified 

25 in critical care who primarily deliver care in intenVerDate Sep 11 2014 23:36 Nov 24, 2014 Jkt 049200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S2966.IS S2966

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1 sive care units, potentially compromising the quality 

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

3 treat only one-third of critically ill patients despite 

4 substantial evidence that these teams lead to im5 proved outcomes. 

6 (7) Ensuring the strength of our critical care 

7 medical delivery infrastructure is integral to the im8 provement of the quality and delivery of health care 

9 in the United States. 

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

11 the current state of the United States critical care medical 

12 delivery system and implement policies to improve the 

13 quality and effectiveness of care delivered to the critically 

14 ill and injured. 

15 SEC. 3. STUDIES ON CRITICAL CARE. 

16 (a) INSTITUTE OF MEDICINE STUDY.— 

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

18 Human Services (in this Act referred to as the ‘‘Sec19 retary’’) shall enter into an agreement with the In20 stitute of Medicine under which, not later than 1 

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

22 Institute will— 

23 (A) conduct an analysis of the current 

24 state of critical care health services in the 

25 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) HEALTH RESOURCES AND SERVICES ADMINIS5 TRATION STUDY.— 

6 (1) IN GENERAL.—The Secretary shall review 

7 and update the Health Resources and Services Ad8 ministration’s 2006 study entitled ‘‘The Critical 

9 Care Workforce: A Study of the Supply and Demand 

10 for Critical Care Physicians’’. 

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

12 Secretary shall expand the scope of the study to ad13 dress the supply and demand of other providers 

14 within the spectrum of critical care delivery, such as 

15 critical care nurses, mid-level providers (such as 

16 physician assistants and nurse practitioners), inten17 sive care unit pharmacists, and intensive care unit 

18 respiratory care practitioners. 

19 SEC. 4. NIH CRITICAL CARE COORDINATING WORKING 

20 GROUP. 

21 (a) ESTABLISHMENT.—The Secretary shall establish 

22 a working group within the National Institutes of Health 

23 to be known as the Critical Care Coordinating Working 

24 Group (in this section referred to as the ‘‘Working 

25 Group’’). 


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

2 the membership of the Working Group includes represent3 atives throughout the National Institutes of Health and 

4 any other component of the Department of Health and 

5 Human Services, as the Secretary determines appropriate 

6 to increase agency coordination on critical care, and based 

7 on existing resources, such as— 

8 (1) the National Heart, Lung, and Blood Insti9 tute; 

10 (2) the National Institute of Nursing Research; 

11 (3) the Eunice Kennedy Shriver National Insti12 tute of Child Health and Human Development; 

13 (4) the National Institute of General Medical 

14 Sciences; 

15 (5) the National Institute on Aging; and 

16 (6) the National Institute of Minority Health. 

17 (c) DUTIES.—The Working Group shall— 

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

19 the National Institutes of Health and any other 

20 component of the Department of Health and Human 

21 Services, as the Secretary determines appropriate for 

22 advancing research and research training in the crit23 ical care setting; 


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1 (2) coordinate funding opportunities that in2 volve multiple components of the Department of 

3 Health and Human Services; 

4 (3) catalyze the development of new funding op5 portunities; 

6 (4) inform investigators about funding opportu7 nities in their areas of interest; 

8 (5) represent the National Institutes of Health 

9 in government-wide efforts to improve the Nation’s 

10 critical care system; 

11 (6) coordinate the collection and analysis of in12 formation on current research of the National Insti13 tutes of Health relating to the care of the critically 

14 ill and injured and identify gaps in such research; 

15 (7) provide an annual report to the Director of 

16 the National Institutes of Health regarding research 

17 efforts of the Institutes relating to the care of the 

18 critically ill and injured; and 

19 (8) make recommendations in each such report 

20 on how to strengthen partnerships within the Na21 tional Institutes of Health and between the Depart22 ment of Health and Human Services and public and 

23 private entities to expand collaborative, cross-cutting 

24 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 shall carry 

6 out a demonstration project under Section 1115A of the 

7 Social Security Act (42 U.S.C. 1315a), designed to im8 prove the quality and efficiency of care provided to criti9 cally ill and injured patients receiving critical care in in10 tensive care units or other areas of acute care hospitals. 

11 (b) ACTIVITIES UNDER DEMONSTRATION

12 PROJECT.—The activities conducted under the demonstra13 tion project under subsection (a) may, in addition to any 

14 other activity specified by the Center for Medicare and 

15 Medicaid Innovation, include activities that seek to— 

16 (1) improve the coordination and transitions of 

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

18 point of care; 

19 (2) incorporate value-based purchasing meth20 odologies or novel informatics, monitoring, or other 

21 methodologies to eliminate error, improve outcomes, 

22 and reduce waste from the delivery of critical care; 

23 (3) improve prediction models that help health 

24 care providers and hospitals identify patients at high 

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1 line care delivery to prevent unexpected hospital re2 admissions for critical illnesses; and 

3 (4) utilize bundled payment approaches and in4 centive care redesign, such as efforts to facilitate 

5 and support comprehensive team delivered care. 

Æ 


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