I 

110TH CONGRESS 

1ST SESSION H. R. 1174 

To amend title XVIII of the Social Security Act to require public reporting 

of health care-associated infections data by hospitals and ambulatory 

surgical centers and to permit the Secretary of Health and Human 

Services to establish a pilot program to provide incentives to hospitals 

and ambulatory surgical centers to eliminate the rate of occurrence 

of such infections. 

IN THE HOUSE OF REPRESENTATIVES 

FEBRUARY 16, 2007 

Mr. TIM MURPHY of Pennsylvania (for himself, Mrs. MYRICK, Mr. BOSWELL, 

and Ms. CORRINE BROWN of Florida) introduced the following bill; which 

was referred to the Committee on Ways and Means, and in addition to 

the Committee on Energy and Commerce, 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 amend title XVIII of the Social Security Act to require 

public reporting of health care-associated infections data 

by hospitals and ambulatory surgical centers and to permit the Secretary of Health and Human Services to 

establish a pilot program to provide incentives to hospitals and ambulatory surgical centers to eliminate the 

rate of occurrence of such infections. 

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


hmoore on PROD1PC68 with HMBILLS
2 

•HR 1174 IH

1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Healthy Hospitals Act 

3 of 2007’’. 

4 SEC. 2. FINDINGS. 

5 Congress finds the following: 

6 (1) Health care costs in the United States are 

7 rising. From 2004 through 2005, the medical costs 

8 for a four-person household increased by 9.1 percent 

9 to $12,214. A significant portion of these increased 

10 costs are attributable to health care-associated infec11 tions. When a patient contracts such an infection, 

12 that cost is passed on to the insurance companies, 

13 State and Federal governments, or individuals. 

14 (2) Health care-associated infections contribute 

15 to over $50,000,000,000 in annual medical costs. An 

16 acquired infection adds $150,000 to a medical bill 

17 per patient. 

18 (3) The Centers for Disease Control and Pre19 vention reports that there are an estimated 

20 2,000,000 cases of health care-associated infections 

21 and an estimated 90,000 deaths related to such in22 fections annually. 

23 (4) Only six States require hospitals to report 

24 their health care-associated infection rates. Only one 

25 State makes that information available to the public 

26 for each hospital. 


hmoore on PROD1PC68 with HMBILLS
3 

•HR 1174 IH

1 (5) Health care-associated infections include 

2 surgical site infections, ventilator associated pneu3 monia, central line related (IV) blood infections, uri4 nary tract infections, methicillin-resistant Staphy5 lococcus aureus (MRSA) infections, and other types 

6 of infections. These infections are transmitted to pa7 tients when there is inadequate adherence to clean 

8 sanitation and patient safety procedures that would 

9 otherwise prevent infectious disease. A study in the 

10 American Journal of Medical Quality of almost 

11 12,000 hospitalizations reports that hospital proce12 dures, not the sickness of the patient at the time of 

13 admission, tended to be the primary cause of these 

14 infections. 

15 (6) Hospitals and other health care providers 

16 have been able to drastically reduce infection rates 

17 by strict adherence to clean sanitation techniques, 

18 including: 

19 (A) Handwashing before and after contact 

20 with any patient. 

21 (B) Sterilizing all equipment used with pa22 tients. 

23 (C) Clean up before and after patient pro24 cedures. 


hmoore on PROD1PC68 with HMBILLS
4 

•HR 1174 IH

1 (D) Proper use of antibiotics before and 

2 after surgery. 

3 (E) Pre-testing patients on admission to 

4 evaluate the presence of an infection (such as 

5 MRSA). 

6 (F) Use of infection control boards at hos7 pitals to monitor and manage procedures. 

8 (7) The National Surgical Infection Prevention 

9 Project found in a study of over 34,000 patients 

10 treated nationwide that more than 44 percent of pa11 tients did not receive antibiotic doses within the rec12 ommended time frame. In addition, the American 

13 Journal of Infection Control reports that 70 percent 

14 of health care workers do not adhere to 

15 handwashing and sterilization procedures. 

16 (8) Hospitals have successfully reduced infec17 tions by improving patient safety. For example, Alle18 gheny General Hospital in Pennsylvania reduced the 

19 rate of central line-acquired infections to almost zero 

20 within 90 days by educating and training health care 

21 staff on infection control resulting in savings in 

22 three years of over $2,000,000. A major teaching 

23 hospital in St. Louis reported a reduction in central 

24 line acquired infection rates through introduction of 

25 an educational program for all staff resulting in cost 


hmoore on PROD1PC68 with HMBILLS
5 

•HR 1174 IH

1 savings of over $1,500,000. Mercy Health Center in 

2 Oklahoma has performed 400 surgeries without any 

3 infections by utilizing antibiotics and clean proce4 dures. 

5 (9) Uniform and accurate public reporting of 

6 health care-associated infections by hospitals and 

7 ambulatory surgical centers will allow health care 

8 providers to target their efforts to reduce the occur9 rence of health care-associated infections, enhance 

10 consumer choice of health care providers, reduce 

11 health care costs, and save lives. 

12 SEC. 3. REQUIREMENT FOR PUBLIC REPORTING OF 

13 HEALTH CARE-ASSOCIATED INFECTIONS 

14 DATA BY HOSPITALS AND AMBULATORY SUR15 GICAL CENTERS. 

16 (a) REQUIRED REPORTING.— 

17 (1) HOSPITALS.—Subsection (a)(1) of section 

18 1866 of the Social Security Act (42 U.S.C. 1395cc) 

19 is amended— 

20 (A) in subparagraph (U), by striking 

21 ‘‘and’’ at the end; 

22 (B) in subparagraph (V), by striking the 

23 period at the end and inserting ‘‘, and’’; and 

24 (C) by inserting after subparagraph (V) 

25 the following new subparagraph: 


hmoore on PROD1PC68 with HMBILLS
6 

•HR 1174 IH

1 ‘‘(W) in the case of a hospital or critical 

2 access hospital, to report to the Secretary data 

3 in accordance with subsection (k)(1).’’. 

4 (2) AMBULATORY SURGICAL CENTERS.—Section 

5 1832(a)(2)(F)(i) of such Act (42 U.S.C. 

6 1395k(a)(2)(F)(i)) is amended by inserting after 

7 ‘‘other standards’’ the following: ‘‘, including the re8 porting to the Secretary of data in accordance with 

9 section 1866(k)(1),’’. 

10 (b) DATA REPORTING AND PUBLIC POSTING OF

11 HEALTH CARE-ASSOCIATED INFECTIONS BY HOSPITALS

12 AND AMBULATORY SURGICAL CENTERS.—Section 1866 of 

13 such Act (42 U.S.C. 1395cc) is further amended by add14 ing at the end the following new subsection: 

15 ‘‘(k) DATA REPORTING AND PUBLIC AVAILABILITY

16 OF HEALTH CARE-ASSOCIATED INFECTIONS BY HOS17 PITALS AND AMBULATORY SURGICAL CENTERS.— 

18 ‘‘(1) QUARTERLY REPORTING REQUIREMENT.— 

19 Not later than 45 days after the end of a calendar 

20 quarter (beginning more than one year after the 

21 date of the enactment of this subsection), a hospital 

22 or ambulatory surgical center shall report to the 

23 Secretary the rate of each health care-associated in24 fection selected under paragraph (2) occurring in the 

25 hospital or center, respectively, during the calendar 


hmoore on PROD1PC68 with HMBILLS
7 

•HR 1174 IH

1 quarter and information on relevant risk factors (re2 lating to susceptibility of patients to each such infec3 tion) that may affect such rate. 

4 ‘‘(2) SELECTION OF HEALTH CARE-ASSOCIATED

5 INFECTIONS.—For purposes of this subsection, the 

6 Secretary shall select one or more health care-associ7 ated infections. 

8 ‘‘(3) PUBLIC POSTING OF DATA.—The Sec9 retary shall promptly post, on the official public 

10 Internet site of the Department of Health and 

11 Human Services, the data reported under paragraph 

12 (1). Such data shall be set forth in a manner that 

13 promotes the comparison of the relative rate of oc14 currence of each health care-associated infection se15 lected under paragraph (2), taking into account the 

16 relevant risk factors reported under such paragraph, 

17 among hospitals and ambulatory surgical centers. 

18 ‘‘(4) ANNUAL REPORT TO CONGRESS.—For 

19 each year for which data is reported under para20 graph (1) for any calendar quarter in the year, the 

21 Secretary shall submit to Congress a report that 

22 summarizes each of the following: 

23 ‘‘(A) The rates of occurrence of each 

24 health care-associated infection selected under 


hmoore on PROD1PC68 with HMBILLS
8 

•HR 1174 IH

1 paragraph (2) in hospitals and ambulatory sur2 gical centers during such year. 

3 ‘‘(B) Factors that contribute to the occur4 rence of each such infection. 

5 ‘‘(C) The measures applied by hospitals 

6 and ambulatory surgical centers to reduce each 

7 such infection and the effect of such measures 

8 during such year. 

9 ‘‘(D) The total increases or decreases in 

10 health care costs that resulted from increases or 

11 decreases in the rates of occurrence of each 

12 such infection during such year. 

13 ‘‘(E) Recommendations for best practices 

14 to eliminate the rates of occurrence of each 

15 such infection in hospitals and ambulatory sur16 gical centers. 

17 ‘‘(5) CIVIL MONEY PENALTY.—The Secretary 

18 may impose a civil money penalty of not more than 

19 $10,000 for each knowing violation of paragraph (1) 

20 by a hospital or ambulatory surgical center. A civil 

21 money penalty under this paragraph shall be im22 posed and collected in the same manner as a civil 

23 money penalty under subsection (a) of section 

24 1128A is imposed and collected under that section, 

25 except that, notwithstanding subsection (f) of such 


hmoore on PROD1PC68 with HMBILLS
9 

•HR 1174 IH

1 section, if the Secretary designs and implements a 

2 pilot program under section 4(a) of the Healthy 

3 Hospitals Act of 2007 (relating to the health care4 associated infections pilot program), amounts recov5 ered under this paragraph shall be paid to the Sec6 retary and shall be available to carry out such pilot 

7 program. 

8 ‘‘(6) NON-PREEMPTION OF STATE LAWS.— 

9 Nothing in this subsection shall be construed as pre10 empting or otherwise affecting any provision of 

11 State law relating to the disclosure of additional in12 formation on health care-associated infections or pa13 tient safety procedures for a hospital or ambulatory 

14 surgical center. 

15 ‘‘(7) HEALTH CARE-ASSOCIATED INFECTION

16 DEFINED.—For purposes of this subsection, the 

17 term ‘health care-associated infection’— 

18 ‘‘(A) means, as defined by the Centers for 

19 Disease Control and Prevention, an infection 

20 caused from bacteria or a virus that— 

21 ‘‘(i) is a localized or systemic condi22 tion that results from an adverse reaction 

23 to the presence of an infectious agent or 

24 its toxin and that was not present or incuVerDate Aug 31 2005 03:50 Feb 22, 2007 Jkt 059200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H1174.IH H1174

hmoore on PROD1PC68 with HMBILLS
10 

•HR 1174 IH

1 bating at the time of admission of a pa2 tient to the hospital involved; 

3 ‘‘(ii) is present at any time after ad4 mission and before discharge of such pa5 tient; and 

6 ‘‘(iii) could reasonably have been pre7 vented had patient safety measures, plans, 

8 and guidelines been adopted and followed; 

9 and 

10 ‘‘(B) includes surgical site infections, ven11 tilator associated pneumonia, central line re12 lated (IV) blood infections, urinary tract infec13 tions, methicillin-resistant Staphylococcus 

14 aureus (MRSA) infections, clostridium difficile 

15 infections, and any additional infections speci16 fied by the Secretary. 

17 ‘‘(8) APPLICATION TO CRITICAL ACCESS HOS18 PITALS.—For purposes of this subsection, the term 

19 ‘hospital’ shall include a critical access hospital.’’. 

20 (c) AUTHORIZATION OF APPROPRIATIONS.—To carry 

21 out this section, there are authorized to be appropriated 

22 such sums as may be necessary for each of fiscal years 

23 2008 through 2010. 


hmoore on PROD1PC68 with HMBILLS
11 

•HR 1174 IH

1 SEC. 4. MEDICARE PILOT PROGRAM TO REDUCE HEALTH 

2 CARE-ASSOCIATED INFECTION RATES. 

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

4 Human Services is authorized to design and implement 

5 a pilot program under title XVIII of the Social Security 

6 Act to provide financial incentives or grants to hospitals 

7 and ambulatory surgical centers, as selected by the Sec8 retary in accordance with subsection (b), that demonstrate 

9 to the satisfaction of the Secretary a reduction in the rate 

10 of occurrence (or elimination) of health care-associated in11 fections in the applicable hospital or ambulatory surgical 

12 center. 

13 (b) SELECTION OF HOSPITALS AND AMBULATORY

14 SURGICAL CENTERS.—In carrying out subsection (a), the 

15 Secretary of Health and Human Services shall select hos16 pitals and ambulatory surgical centers— 

17 (1) that are capable of accurately monitoring 

18 and reporting the rate of occurrence of health care19 associated infections; and 

20 (2) the participation of which in such program 

21 will likely result in the greatest scientific and health 

22 benefit for purposes of reducing the rate of occur23 rence of such infections. 

24 (c) LIMITATION.—Under the pilot program under 

25 this section the aggregate financial incentives provided 

26 under the program for reduction in infections in a period 


hmoore on PROD1PC68 with HMBILLS
12 

•HR 1174 IH

1 shall not exceed 10 percent of the amount (estimated by 

2 the Secretary) by which Federal expenditures under title 

3 XVIII of the Social Security Act are reduced in such pe4 riod as a result of such reduction in infections. 

5 (d) HEALTH CARE-ASSOCIATED INFECTION DE6 FINED.—For purposes of this section, the term ‘‘health 

7 care-associated infection’’ has the meaning given such 

8 term under section 1866(k)(6) of the Social Security Act, 

9 as added by section 3(b). 

10 (e) APPLICATION TO CRITICAL ACCESS HOS11 PITALS.—For purposes of this section, the term ‘‘hos12 pital’’ shall include a critical access hospital. 

13 (f) AUTHORIZATION OF APPROPRIATIONS.—To carry 

14 out this section there are authorized to be appropriated 

15 such sums as may be necessary for each of fiscal years 

16 2008 through 2010. 

17 SEC. 5. SENSE OF CONGRESS. 

18 It is the sense of Congress that health care providers 

19 and facilities should take measures to reduce the rate of 

20 occurrence of health care-associated infections to zero, 

21 with respect to patients to whom such providers and facili22 ties furnish services. 

Æ 


hmoore on PROD1PC68 with HMBILLS