I 
109TH CONGRESS 
1ST SESSION H. R. 4349 
To require Medicare providers to disclose publicly staffing and performance 
in order to promote improved consumer information and choice. 
IN THE HOUSE OF REPRESENTATIVES 
NOVEMBER 16, 2005 
Mr. HINCHEY (for himself, Mrs. CAPPS, Mr. DEFAZIO, Mr. DOGGETT, Mr. 
FILNER, Mr. JEFFERSON, Mr. KUCINICH, Mr. LANTOS, Mrs. MCCARTHY, 
Mr. MCNULTY, Mr. PAYNE, Mr. STARK, Mr. TOWNS, Mr. WAXMAN, and 
Ms. WOOLSEY) introduced the following bill; which was referred to the 
Committee on Ways and Means, and in addition to the Committee on En-
ergy 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 require Medicare providers to disclose publicly staffing 
and performance in order to promote improved consumer 
information and choice. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Patient Safety Act of 
2005’’. 
SEC. 2. FINDINGS. 
The Congress finds as follows:
(1) The past decade has been a turbulent time 
for health care facilities and nurses. 
(2) Recent research published in the Journal of 
the American Medical Association has shown that 
registered nurse staffing levels have a significant im-
pact on preventable deaths in hospitals, and that the 
odds of patient mortality increase 7 percent for 
every additional patient added to the average reg-
istered nurse’s workload. 
(3) Recent research supported by the Agency 
for Health Care Research and Quality, the Centers 
for Medicare & Medicaid Services, and the National 
Institute for Nursing Research shows that inad-
equate registered nurse staffing is directly related to 
serious complications such as pneumonia, upper gas-
trointestinal bleeding, and urinary tract infections, 
as well as failure to stop deaths caused by shock, 
cardiac arrest, sepsis, and deep vein thrombosis in 
hospitalized patients. 
(4) The Joint Commission on the Accreditation 
of Healthcare Organizations recently reported that 
inadequate nurse staffing contributes to nearly a 
quarter of all unexpected incidents that kill or injure 
hospitalized patients.
(5) The Institute of Medicine has reported that 
both nursing-to-resident staffing levels and the ratio 
of professional nurses to other nursing personnel are 
important indicators of high quality of care, and 
that the participation of registered nurses in direct 
care giving and in the provision of hands-on guid-
ance to nurse assistants is positively associated with 
quality of care in nursing facilities. 
(6) Recent research conducted by the Centers 
for Medicare & Medicaid Services found strong, ob-
jective proof that nurse staffing in nursing homes is 
directly related to quality measures such as sepsis, 
urinary tract infections, incidence of pressure sores, 
resisting care improvement, and weight loss. 
(7) As a payer for inpatient and outpatient hos-
pital services for individuals entitled to benefits 
under the medicare and medicaid programs estab-
lished under titles XVIII and XIX of the Social Se-
curity Act, the Federal Government has a compelling 
interest in promoting the safety of such individuals 
by requiring providers participating in such pro-
grams to provide these individuals with information 
regarding nurse staffing levels.
SEC. 3. PUBLIC DISCLOSURE OF STAFFING AND OUTCOMES 
DATA. 
(a) DISCLOSURE OF STAFFING AND OUTCOMES.— 
Any provider under the medicare program shall, as a con-
dition of continued participation in such program, make 
publicly available information regarding nurse staffing 
and patient outcomes as specified by the Secretary. Such 
information shall include at least the following: 
(1) The number of registered nurses providing 
direct patient care. This information shall be ex-
pressed both in raw numbers, in terms of total hours 
of nursing care per patient (including adjustment for 
case mix and acuity), and as a percentage of nursing 
staff, and shall be broken down in terms of the total 
nursing staff, each unit, and each shift. 
(2) The number of licensed practical nurses or 
licensed vocational nurses providing direct care. This 
information shall be expressed both in raw numbers, 
in terms of total hours of nursing care per patient 
(including adjustment for case mix and acuity), and 
as a percentage of nursing staff, and shall be broken 
down in terms of the total nursing staff, each unit, 
and each shift. 
(3) Numbers of unlicensed personnel utilized to 
provide direct patient care. This information shall be 
expressed both in raw numbers and as a percentage
of nursing staff and shall be broken down in terms 
of the total nursing staff, each unit, and each shift. 
(4) The average number of patients per reg-
istered nurse, licensed practical nurse, or unlicensed 
personnel providing direct patient care. This infor-
mation shall be broken down in terms of the total 
nursing staff, each unit, and each shift. 
(5) Risk-adjusted patient mortality rate (in raw 
numbers and by diagnosis or diagnostic-related 
group). 
(6) Incidence of adverse patient care incidents, 
including as such incidents at least medication er-
rors, patient injury, pressure ulcers, nosocomial in-
fections, and nosocomial urinary tract infections. 
(7) Methods used for determining and adjusting 
staffing levels and patient care needs and the pro-
vider’s compliance with these methods. 
(b) DISCLOSURE OF COMPLAINTS.—Data regarding 
complaints filed with the State agency, the Centers for 
Medicare & Medicaid Services, or an accrediting agency, 
compliance with the standards of which have been deemed 
to demonstrate compliance with conditions of participation 
under the medicare program, and data regarding inves-
tigations and findings as a result of those complaints and
the findings of scheduled inspection visits, shall be made 
publicly available. 
(c) INFORMATION ON DATA.—All data made publicly 
available under this section shall indicate the source and 
currency of the data provided. 
(d) WAIVER FOR SMALL PROVIDERS.—The Secretary 
may reduce reporting requirements under this section in 
the case of a small provider (as defined by the Secretary) 
for whom the imposition of the requirements would be un-
duly burdensome. 
(e) REPORTING
TO SECRETARY.—Providers shall 
submit to the Secretary in a uniform manner (as pre-
scribed by the Secretary) the nursing staff information de-
scribed in subsection (a) through electronic means not less 
frequently than quarterly. 
(f) SECRETARIAL
RESPONSIBILITIES.—The Sec-
retary shall— 
(1) make the information submitted pursuant 
to subsection (a) publicly available, including by 
publication of such information on the Internet site 
of the Department of Health and Human Services; 
and 
(2) provide for the auditing of such information 
for accuracy as a part of the process of determining