I 
111TH CONGRESS 
1ST SESSION H. R. 2948 
To amend title IX of the Public Health Service Act to provide for the 
implementation of best practices in the delivery of health care in the 
United States, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 18, 2009 
Mr. LEVIN (for himself, Mr. HIGGINS, Mr. DOGGETT, Ms. HIRONO, Mr. POM-
EROY, and Mr. ETHERIDGE) introduced the following bill; which was re-
ferred to the Committee on Energy and Commerce 
A BILL 
To amend title IX of the Public Health Service Act to 
provide for the implementation of best practices in the 
delivery of health care in the United States, and for 
other purposes. 
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 ‘‘Healthcare Improve-
ments for Generating High Performance (HIGH Perform-
ance) Act of 2009’’. 
SEC. 2. FINDINGS. 
The Congress finds the following: 
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(1) The United States has some of the best 
doctors and hospitals in the world, but, as a whole, 
the system is not providing the quality of care it has 
the potential to deliver. 
(2) On average, patients receive recommended 
evidence-based therapies only 55 percent of the time. 
(3) In the United States, it takes an average of 
17 years for an established clinical guideline to 
reach the bedside. 
(4) More people die from medical errors and 
hospital-acquired infections in a given year than 
from AIDS, motor vehicle wrecks, or breast cancer 
combined. Many of these errors and infections are 
preventable when best practices are utilized. 
(5) The United States ranks far behind other 
countries in many measures of health care quality. 
(6) The cause of poor quality is not a lack of 
individual commitment, but a lack of assistance for 
providers to implement best practices that are prov-
en to work. 
(7) Experiences in Michigan illustrate the im-
provement that can be achieved when hospitals and 
physicians have the tools they need to implement 
best practices in health care. After Michigan insti-
tuted a program to help hospitals implement best 
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practices to prevent hospital-acquired infections in 
the intensive care unit (ICU), infections went down 
by 66 percent in the first 3 months. After 18 
months, Michigan’s ICUs cut infection rates so low 
that they outperformed 90 percent of ICUs nation-
wide. 
(8) In that time, it is estimated that Michigan 
hospitals saved $75,000,000 and over 1,500 lives. If 
these results in reducing infections alone were 
achieved nationwide, it is estimated that the United 
States could save $13,000,000,000 over 10 years. 
(9) There is an urgent need to accelerate the 
implementation of best practices in health care deliv-
ery to improve the quality and value of health care. 
SEC. 3. IMPLEMENTATION OF BEST PRACTICES TO IM-
PROVE HEALTH CARE QUALITY. 
Title IX of the Public Health Service Act (42 U.S.C. 
299 et seq.) is amended by adding at the end the fol-
lowing: 
‘‘PART E—IMPLEMENTATION OF BEST 
PRACTICES TO IMPROVE HEALTH CARE QUALITY 
‘‘SEC. 941. ESTABLISHMENT OF NATIONAL PRIORITIES AND 
GOALS. 
‘‘(a) IN GENERAL.—The Secretary shall establish na-
tional priorities and goals for quality improvement in the 
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delivery of health care services in the United States. In 
establishing these priorities and goals, the Secretary shall 
consult with a multistakeholder group convened for the 
purposes of reviewing available evidence and recom-
mending national quality improvement targets. Such 
group shall include representatives of the various interests 
and organizations needed to enable change, including con-
sumers, physicians, nurses, hospitals and other care deliv-
ery organizations, non-Federal purchasers of care, health 
care oversight or accrediting bodies, research organiza-
tions, and entities with successful experience in quality im-
provement and quality measurement. 
‘‘(b) AREAS
FOR IMPROVEMENT.—Priorities and 
goals may be established in at least the following areas 
recommended by the Institute of Medicine: safety, effec-
tiveness, patient-centeredness, timeliness, efficiency, and 
equity. 
‘‘(c) PERIODIC UPDATES OF NATIONAL PRIORITIES 
AND GOALS.—The Secretary shall update the national pri-
orities and goals established under this section not less 
frequently than once every 3 years. 
‘‘(d) APPLICATION OF NATIONAL PRIORITIES.—The 
Secretary shall use the national priorities established and 
updated under this section to coordinate, accelerate, and 
provide for quality improvement activities and initiatives 
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in the delivery of health care services in the United States, 
including through the work of the Center for Health Ex-
tension established under section 942. 
‘‘(e) ASSESSMENT OF PROGRESS TOWARD NATIONAL 
GOALS.—The Secretary shall submit an annual report to 
the Congress and the public containing an assessment of 
progress toward the national quality improvement goals. 
‘‘(f) INTERAGENCY COORDINATION.—The Secretary 
shall convene an interagency committee, which shall in-
clude representatives from the Agency for Healthcare Re-
search and Quality, including the Center for Health Ex-
tension established under section 942, the National Insti-
tutes of Health, the Centers for Disease Control and Pre-
vention, the Centers for Medicare and Medicaid Services, 
the Health Resources and Services Administration, the In-
dian Health Service, the Department of Defense, the Vet-
erans Health Administration, and other agencies the Sec-
retary deems appropriate, for the purpose of coordinating 
the quality improvement work of such agencies, including 
the application of the national priorities. 
‘‘SEC. 942. ESTABLISHMENT OF THE CENTER FOR HEALTH 
EXTENSION. 
‘‘(a) ESTABLISHMENT.—The Secretary shall estab-
lish within the Agency for Healthcare Quality and Re-
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search a Center for Health Extension (hereinafter referred 
to as the ‘Center’). 
‘‘(b) DIRECTOR.—The Center shall be headed by a 
Director who shall oversee the operations of the Center 
and of the Regional Health Extension Centers established 
under section 944. 
‘‘SEC. 943. MISSION AND FUNCTIONS OF THE CENTER FOR 
HEALTH EXTENSION. 
‘‘(a) MISSION.—The mission of the Center is to im-
prove health care quality by assisting health care providers 
to implement and improve upon clinical, managerial, and 
health care delivery best practices, and to evaluate 
progress in improving patient outcomes. 
‘‘(b) FUNCTIONS.— 
‘‘(1) IDENTIFY
AND
DEVELOP
BEST
PRAC-
TICES.—The Center shall identify and develop clin-
ical, managerial, and health care delivery best prac-
tices for implementation in quality improvement ac-
tivities. 
‘‘(2) ASSIST WITH THE IMPLEMENTATION OF 
BEST
PRACTICES.—The Center shall provide vol-
untary training and technical assistance to hospitals, 
other health care facilities, and clinician practices to 
assist with the implementation of best practices. 
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‘‘(3) MEASURE PATIENT OUTCOMES AND SATIS-
FACTION.—The Center shall provide for the meas-
urement of patient outcomes and satisfaction, be-
fore, during, and after implementation of quality im-
provement activities. 
‘‘(4) EVALUATE
EFFECTIVENESS
OF
ACTIVI-
TIES.—The Center shall evaluate the effectiveness of 
quality improvement activities, and progress improv-
ing patient outcomes. 
‘‘(c) IDENTIFICATION OF BEST PRACTICES.— 
‘‘(1) IN GENERAL.—The Center shall provide 
for the identification of highly effective clinical, man-
agerial, and health care delivery practices and inno-
vations that result in excellent patient outcomes and 
satisfaction, and can be adapted for use by various 
health care providers. 
‘‘(2) SOURCES OF BEST PRACTICES.—The Cen-
ter may identify practices and innovations described 
in paragraph (1) from the following sources. 
‘‘(A) PROVIDERS
AND
OTHER
HEALTH 
CARE
ENTITIES.—The Center may identify 
practices and innovations employed by hos-
pitals, health care facilities, clinician practices, 
community cooperatives, and other health care 
entities. 
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‘‘(B) EMPIRICAL
STUDIES.—The Center 
may identify practices and innovations from a 
review of relevant empirical studies. 
‘‘(C) PUBLIC
AND
PRIVATE
ENTITIES.— 
The Center may identify practices and innova-
tions developed by public and private entities in 
the United States and abroad. 
‘‘(D) OTHER SOURCES.—The Center may 
identify practices and innovations from other 
sources as the Secretary deems appropriate. 
‘‘(d) DEVELOPMENT OF BEST PRACTICES.— 
‘‘(1) IN GENERAL.—The Center shall provide 
for the development of highly effective clinical, man-
agerial, and health care delivery practices, taking 
into account the requirements described in para-
graph (2). 
‘‘(2) 
REQUIREMENTS.—Practices 
developed 
under paragraph (1) shall— 
‘‘(A) be supported by empirical evidence 
showing that they have a high likelihood of im-
proving patient outcomes and satisfaction; 
‘‘(B) be specified with sufficient detail of 
the individual processes, steps, training, skills, 
and knowledge required for implementation and 
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incorporation into workflow of health care prac-
titioners in a variety of settings; 
‘‘(C) be designed to be readily adapted by 
health care practitioners; 
‘‘(D) where applicable, be designed to be 
consistent with standards adopted by the Sec-
retary (under section 3004 of the Public Health 
Service Act) for health information technology 
used in the collection and reporting of quality 
information, including for purposes of the dem-
onstration of meaningful use of certified Elec-
tronic Medical Record technology by physicians 
and hospitals under the Medicare program 
(under sections 1842(o)(2) and 1886(n)(3), re-
spectively, of the Social Security Act (42 U.S.C. 
1395w–4(o)(2), 1395ww(n)(3))); and 
‘‘(E) where applicable, assist health care 
practitioners in working with other health care 
practitioners across the continuum of care and 
in engaging patients and their families in im-
proving the care and patient outcomes. 
‘‘(3) COLLABORATION
WITH
HEALTH
CARE 
PROVIDERS AND OTHER ENTITIES.—The Center may 
collaborate with health care providers and other enti-
ties to foster the development of highly effective 
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practices and innovations to improve health care 
quality. 
‘‘(4) ATTENTION TO HEALTH CARE DELIVERY 
DESIGN.—The Center shall specifically provide for 
the development of best practices for health care de-
livery design as described in section 943(g). 
‘‘(5) ONGOING REVIEW AND IMPROVEMENT.— 
The Center shall provide for regular review, updat-
ing, and improvement of practices developed under 
this subsection. 
‘‘(e) TRAINING AND EDUCATION FOR HEALTH CARE 
PROVIDERS.— 
‘‘(1) IN
GENERAL.—Acting through the Re-
gional Health Care Extension Centers established in 
section 944 (hereinafter referred to as ‘Extension 
Centers’), the Center shall provide for voluntary 
training activities for hospitals, other facilities, and 
clinician practices to assist with the implementation 
of best practices and innovations identified under 
subsection (c) or developed under subsection (d) 
that— 
‘‘(A) further the priorities established 
under section 941, once such priorities have 
been established; 
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‘‘(B) have the greatest impact on patient 
outcomes and satisfaction; and 
‘‘(C) are determined to be readily employ-
able in health care settings. 
‘‘(2) TECHNICAL
ASSISTANCE.—The Center 
shall work through the Extension Centers to carry 
out the following functions: 
‘‘(A) 
ESTABLISHMENT
OF
PARTICIPA-
TION.—The Extension Centers shall seek the 
voluntary participation of hospitals, health fa-
cilities, and clinician practices in a region to 
enter into arrangements to receive assistance in 
implementing highly effective practices identi-
fied under subsection (c) or developed under 
subsection (d). Hospitals, health facilities, and 
clinician practices entering into such arrange-
ments are hereinafter referred to in this sub-
section as ‘collaborating providers’. 
‘‘(B) ESTABLISHMENT OF COLLABORATIVE 
TEAM.—The Extension Centers may require 
collaborating providers to designate a group of 
members from among the professional and ad-
ministrative staff who are responsible for the 
implementation of the quality improvement ac-
tivity or initiative. 
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‘‘(C) ASSESSMENT
OF
EXISTING
PRAC-
TICES.—The Extension Centers shall conduct 
an assessment of the existing practices as com-
pared to the identified highly effective practice 
at each hospital, facility, or practice that par-
ticipates in an arrangement under this sub-
section. 
‘‘(D) DEVELOPMENT OF IMPLEMENTATION 
PLAN.—Each collaborating provider shall work 
with the Extension Center to develop an imple-
mentation plan for the incorporation of the 
highly effective practice into the care of the 
provider. 
‘‘(E) TRAINING FOR COLLABORATING PRO-
VIDERS.—Staff of the Extension Center shall 
work with the collaborating providers to execute 
the implementation plan. Such staff shall pro-
vide instruction and training through electronic 
media, in-person training sessions, and data 
analysis to collaborating providers. Such staff 
shall work with the collaborating providers to 
carry out this paragraph. 
‘‘(F) MEASUREMENT OF PROGRESS.—Pur-
suant to a data protection agreement entered 
into between the Extension Center and the col-
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laborating provider, the Extension Center shall 
collect data to measure best practice implemen-
tation and patient outcomes before, during, and 
after implementation of quality improvement 
activities using, to the extent practicable, data 
already reported for other purposes by collabo-
rating providers. Where applicable, the Exten-
sion Center shall also collect data to measure 
the culture of safety. 
‘‘(G) TIMELY
FEEDBACK
TO
COLLABO-
RATING
PROVIDERS.—The Extension Center 
shall provide to each collaborating provider— 
‘‘(i) analysis conducted by the Exten-
sion Center on the collaborating provider’s 
progress implementing the highly effective 
practice and improving patient outcomes, 
and, where applicable, improving the cul-
ture of safety. 
‘‘(ii) information on the collaborating 
provider’s performance as compared to 
other like entities participating in similar 
quality improvement activities, and as 
available, as compared to other like entities 
nationally. 
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‘‘(H) CULTURE CHANGE.—The Extension 
Center may incorporate into instruction and 
training for collaborating providers activities to 
improve the culture of safety and foster an 
ethic of continual improvement among collabo-
rating providers. 
‘‘(I) MEETINGS.—The Extension Center 
shall provide for meetings of panels of collabo-
rating providers working with Extension Cen-
ters on similar quality improvement activities 
for the purpose of reciprocal learning and infor-
mation exchange. 
‘‘(J) COORDINATION WITH OTHER QUAL-
ITY IMPROVEMENT ENTITIES.—If an Extension 
Center is not the organization holding a con-
tract under section 1153 of the Social Security 
Act or a health information technology regional 
extension center under section 3012(c) of the 
Public Health Service Act, the Extension Cen-
ter shall cooperate with and avoid duplicating 
the activities of these entities. 
‘‘(K) OTHER DUTIES.—Such other duties 
as the Center may specify. 
‘‘(3) INITIAL QUALITY IMPROVEMENT ACTIVI-
TIES.—The Center shall immediately prioritize as-
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sistance for the implementation of best practices 
that have been shown to be effective with respect to 
improvement in the following areas: 
‘‘(A) HAI.—Health care-associated infec-
tions, including reducing catheter-associated 
urinary tract infection, ventilator-associated 
pneumonia, and central line-associated blood-
stream infections. 
‘‘(B) SURGERY.—Hospital and outpatient 
perioperative care, including reducing surgical- 
site infections and surgical errors such as 
wrong-site surgery and retained foreign bodies. 
‘‘(C) ER.—Hospital emergency rooms, in-
cluding the development of comprehensive unit- 
based safety programs, ‘handovers’ of care 
when transferring patients from the emergency 
room to other hospital departments or sites for 
treatment, early identification and treatment 
for sepsis, and use of principles of efficiency of 
design and delivery to improve patient flow. 
‘‘(D) OBSTETRICS.—Obstetrical and neo-
natal care, including the appropriate use of ce-
sarean sections, and the implementation of best 
practices for labor and delivery care. 
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‘‘(E) CARE TRANSITIONS.—Transitions of 
patients between settings, including reduction 
of unnecessary hospital readmissions and in-
creased coordination between teams of unaffili-
ated providers. 
‘‘(f) ASSESSMENT OF EFFECTIVENESS OF QUALITY 
IMPROVEMENT ACTIVITIES.— 
‘‘(1) IMPACT
STATEMENTS.—Each Extension 
Center shall make available to the public and the 
Center impact statements with respect to its activi-
ties to assist health care providers to implement best 
practices. Such impact statements shall contain de- 
identified information on progress implementing 
highly effective practices, the impact of the Exten-
sion Center’s activities on patient outcomes and sat-
isfaction, including lives saved, and cost savings at-
tributable to the activities of the Extension Center, 
and shall include such additional information as the 
Center may specify. 
‘‘(2) AGGREGATE
IMPACT
STATEMENT.—The 
Center shall aggregate the progress reports of the 
Extension Centers into a national impact statement. 
The national impact statement shall contain infor-
mation on the aggregate progress implementing 
highly effective practices, the aggregate impact of 
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the Extension Centers’ activities on patient out-
comes and satisfaction, including lives saved, and 
aggregate cost savings attributable to the activities 
of the Extension Centers, including cost savings to 
Medicare and Medicaid, and shall include such addi-
tional information as the Center may specify. 
‘‘(3) EVALUATION OF EFFECTIVENESS.—To the 
extent practicable, the Center shall evaluate the ef-
fect of implementing individual best practices on im-
proving patient outcomes and satisfaction. 
‘‘(g) HEALTH CARE DELIVERY DESIGN.— 
‘‘(1) IN GENERAL.—The Center shall conduct 
or fund activities to develop superior designs for the 
delivery of health services. This activity may utilize 
tools such as operations research, systems engineer-
ing, rapid design laboratories, cognitive and social 
psychology studies, materials sciences, and statistics. 
‘‘(2) EXAMPLES
OF
ACTIVITIES
TO
BE
CON-
DUCTED.—Health care delivery design activities con-
ducted under this paragraph may examine methods 
to— 
‘‘(A) improve the arrangement of surgical 
suites to facilitate teamwork among physicians, 
nurses, and other members of the care team; 
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‘‘(B) increase the likelihood that clinical 
guidelines are followed in care settings; 
‘‘(C) design medication systems to prevent 
medication errors; 
‘‘(D) improve rounding, handoff, and shift 
changes to improve coordination of patient care; 
‘‘(E) develop discharge practices that im-
prove coordination and reduce confusion and 
duplicative care; 
‘‘(F) craft and implement effective patient 
education procedures; and 
‘‘(G) improve the design and protocols of 
emergency rooms to reduce unsafe conditions 
and ambulance diversions. 
‘‘(3) SOLICITATION
OF
INPUT.—The Center 
shall solicit input from health care providers on 
areas in which development of best practices in 
health care delivery are most needed to improve pa-
tient care and satisfaction. 
‘‘(4) REQUIREMENTS.—The health care delivery 
design improvement activities conducted under this 
paragraph shall— 
‘‘(A) be based on identified need for im-
provement in a specific area of health care de-
livery; 
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‘‘(B) aim to discover or develop designs 
that can be readily adopted by health care pro-
viders and facilities; 
‘‘(C) aim to improve patient outcomes and 
satisfaction; 
‘‘(D) where applicable, be designed to be 
consistent with standards adopted by the Direc-
tor (under section 3004 of the Public Health 
Service Act) for health information technology 
used in the collection and reporting of quality 
information, including for purposes of the dem-
onstration of meaningful use of certified Elec-
tronic Medical Record technology by physicians 
and hospitals under the Medicare program 
(under sections 1842(o)(2) and 1886(n)(3), re-
spectively, of the Social Security Act (42 U.S.C. 
1395w–4(o)(2), 1395ww(n)(3))); and 
‘‘(E) where applicable, assist health care 
practitioners in working with other health care 
practitioners across the continuum of care and 
in engaging patients and their families in im-
proving the care and patient outcomes. 
‘‘(h) RESEARCH
AND RELATED ACTIVITIES.—The 
Center shall conduct or fund research and other knowl-
edge generation activities on the factors that facilitate be-
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