,,ii  #aacth ,,congress  #b;d ,session  
,s4 #biff  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,november #bj1 
#bjad ,ms4 ,baldwin 7for herself and    
,mr4 ,portman7 introduced the following 
bill2 which was read twice and referred 
to the ,committee on ,finance  ,a ,,bill
  ,to improve the understanding and     
coordination of critical care health    
services4  #a4  ,short title  ,this ,act
 may be cited as the ,critical ,care    
,assessment and ,improvement ,act of    
#bjad4  #b4  ,findings2 purposes  7a7   
,findings  ,congress finds the          
following3  7#a7 ,critical care medicine
 is the care for patients whose         
illnesses or injuries present a         
significant danger to life1 limb1 or    
organ function and require comprehensive
 care and constant monitoring1 usually  
in intensive care units 7,i,c,us74  7#b7
 ,each year1 approximately #e1jjj1jjj   
people in the ,united ,states are       
admitted into adult medical1 surgical1  
pediatric1 or neonatal ,i,c,us4  7#c7   

,critical care medicine encompasses a   
wide array of diseases and health       
issues4 ,the care provided in the ,,icu 
is highly specialized and complex due to
 the extreme severity of illness of its 
patient population1 often involving     
multiple disease processes in different 
organ systems at the same time4  7#d7   
,critical care medicine consumes a      
significant amount of financial         
resources1 accounting for more than #ag 
percent of all hospital costs4  7#e7    
,according to a #bjjf report by the     
,health ,resources and ,services        
,administration 7referred to in this    
section as ,,hrsa71 demand in the       
,united ,states for critical care       
medical services is on the rise1 due in 
part to the growing elderly population1 
as individuals over the age of #fe      
consume a large percentage of critical  
care services4  7#f7 ,the ,,hrsa report 
also found that the growing aging       
population will further exacerbate an   
existing shortage of intensivists1 the  

physicians certified in critical care   
who primarily deliver care in intensive 
care units1 potentially compromising the
 quality and availability of care4      
,today1 intensivist-led teams treat only
 one-third of critically ill patients   
despite substantial evidence that these 
teams lead to improved outcomes4  7#g7  
,ensuring the strength of our critical  
care medical delivery infrastructure is 
integral to the improvement of the      
quality and delivery of health care in  
the ,united ,states4  7b7  ,purpose     
,the purpose of this ,act is to assess  
the current state of the ,united ,states
 critical care medical delivery system  
and implement policies to improve the   
quality and effectiveness of care       
delivered to the critically ill and     
injured4  #c4  ,studies on critical care
  7a7  ,institute of ,medicine study    
7#a7  ,in general  ,the ,secretary of   
,health and ,human ,services 7in this   
,act referred to as the ,secretary7     
shall enter into an agreement with the  

,institute of ,medicine under which1 not
 later than #a year after the date of   
the enactment of this ,act1 the         
,institute will--  7,a7 conduct an      
analysis of the current state of        
critical care health services in the    
,united ,states2  7,b7 develop          
recommendations to bolster critical care
 capabilities to meet future demand2 and
  7,c7 submit to ,congress a report     
including the analysis and              
recommendations under subparagraphs 7,a7
 and 7,b74  7#b7  ,issues to be studied 
,the agreement under paragraph 7#a7     
shall1 at a minimum1 provide for the    
following3  7,a7 ,analysis of the       
current critical care system in the     
,united ,states1 including--  7i7 the   
system's capacity and resources1        
including the size of the critical care 
workforce and the availability of health
 information technology and medical     
equipment2  7ii7 the system's strengths1
 limitations1 and future challenges2 and
  7iii7 the system's ability to provide 

adequate care for the critically ill or 
injured in response to a national health
 emergency1 including a pandemic or     
natural disaster4  7,b7 ,analysis and   
recommendations regarding regionalizing 
critical care systems4  7,c7 ,analysis  
regarding the status of critical care   
research in the ,united ,states and     
recommendations for future research     
priorities4  7b7  ,health ,resources and
 ,services ,administration study  7#a7  
,in general  ,the ,secretary shall      
review and update the ,health ,resources
 and ,services ,administration's #bjjf  
study entitled ,the ,critical ,care     
,workforce3 ,a ,study of the ,supply and
 ,demand for ,critical ,care            
,physicians4  7#b7  ,scope  ,in carrying
 out paragraph 7#a71 the ,secretary     
shall expand the scope of the study to  
address the supply and demand of other  
providers within the spectrum of        
critical care delivery1 such as critical
 care nurses1 mid-level providers 7such 
as physician assistants and nurse       

practitioners71 intensive care unit     
pharmacists1 and intensive care unit    
respiratory care practitioners4  #d4    
,,nih ,critical ,care ,coordinating     
,working ,group  7a7  ,establishment    
,the ,secretary shall establish a       
working group within the ,national      
,institutes of ,health to be known as   
the ,critical ,care ,coordinating       
,working ,group 7in this section        
referred to as the ,working ,group74    
7b7  ,membership  ,the ,secretary shall 
ensure that the membership of the       
,working ,group includes representatives
 throughout the ,national ,institutes of
 ,health and any other component of the 
,department of ,health and ,human       
,services1 as the ,secretary determines 
appropriate to increase agency          
coordination on critical care1 and based
 on existing resources1 such as--  7#a7 
the ,national ,heart1 ,lung1 and ,blood 
,institute2  7#b7 the ,national         
,institute of ,nursing ,research2  7#c7 
the ,eunice ,kennedy ,shriver ,national 

,institute of ,child ,health and ,human 
,development2  7#d7 the ,national       
,institute of ,general ,medical         
,sciences2  7#e7 the ,national          
,institute on ,aging2 and  7#f7 the     
,national ,institute of ,minority       
,health4  7c7  ,duties  ,the ,working   
,group shall--  7#a7 serve as the focal 
point and catalyst across the ,national 
,institutes of ,health and any other    
component of the ,department of ,health 
and ,human ,services1 as the ,secretary 
determines appropriate for advancing    
research and research training in the   
critical care setting2  7#b7 coordinate 
funding opportunities that involve      
multiple components of the ,department  
of ,health and ,human ,services2  7#c7  
catalyze the development of new funding 
opportunities2  7#d7 inform             
investigators about funding             
opportunities in their areas of         
interest2  7#e7 represent the ,national 
,institutes of ,health in               
government-wide efforts to improve the  

,nation's critical care system2  7#f7   
coordinate the collection and analysis  
of information on current research of   
the ,national ,institutes of ,health    
relating to the care of the critically  
ill and injured and identify gaps in    
such research2  7#g7 provide an annual  
report to the ,director of the ,national
 ,institutes of ,health regarding       
research efforts of the ,institutes     
relating to the care of the critically  
ill and injured2 and  7#h7 make         
recommendations in each such report on  
how to strengthen partnerships within   
the ,national ,institutes of ,health and
 between the ,department of ,health and 
,human ,services and public and private 
entities to expand collaborative1       
cross-cutting research4  #e4  ,centers  
for ,medicare and ,medicaid ,innovation 
,critical ,care ,demonstration project  
7a7  ,in general  ,not later than one   
year after the date of the enactment of 
this ,act1 the ,secretary shall carry   
out a demonstration project under       

,section #aaae;,a of the ,social        
,security ,act 7#db ,u4,s4,c4 #acae;a71 
designed to improve the quality and     
efficiency of care provided to          
critically ill and injured patients     
receiving critical care in intensive    
care units or other areas of acute care 
hospitals4  7b7  ,activities under      
demonstration project  ,the activities  
conducted under the demonstration       
project under subsection 7a7 may1 in    
addition to any other activity specified
 by the ,center for ,medicare and       
,medicaid ,innovation1 include          
activities that seek to--  7#a7 improve 
the coordination and transitions of care
 to and from an intensive care unit and 
the next point of care2  7#b7           
incorporate value-based purchasing      
methodologies or novel informatics1     
monitoring1 or other methodologies to   
eliminate error1 improve outcomes1 and  
reduce waste from the delivery of       
critical care2  7#c7 improve prediction 
models that help health care providers  

and hospitals identify patients at high 
risk for requiring critical care        
services and streamline care delivery to
 prevent unexpected hospital            
readmissions for critical illnesses2 and
  7#d7 utilize bundled payment          
approaches and incentive care redesign1 
such as efforts to facilitate and       
support comprehensive team delivered    
care4