Healthcare Improvements for Generating High Performance (HIGH Performance) Act of 2009 - Amends the Public Health Service Act to direct the Secretary of Health and Human Services (HHS) to: (1) establish national priorities and goals for quality improvement in the delivery of health care services in the United States; (2) convene an interagency committee to coordinate the health care quality improvement activities of certain federal agencies; and (3) establish a Center for Health Extension (Center) within the Agency for Healthcare Research and Quality of HHS to improve health care quality and evaluate progress in improving patient outcomes.
Requires the Center to: (1) identify and develop clinical, managerial, and health care delivery best practices; (2) provide training and technical assistance to hospitals and health care facilities to implement such best practices; (3) establish Regional Health Care Centers to assist in training and education of health care providers in quality improvement; and (4) provide for public dissemination of information relating to activities and research conducted under this Act.
[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2948 Introduced in House (IH)]
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.
Pomeroy, and Mr. Etheridge) introduced the following bill; which was
referred 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 Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Healthcare Improvements for
Generating High Performance (HIGH Performance) Act of 2009''.
SEC. 2. FINDINGS.
The Congress finds the following:
(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 proven to work.
(7) Experiences in Michigan illustrate the improvement that
can be achieved when hospitals and physicians have the tools
they need to implement best practices in health care. After
Michigan instituted a program to help hospitals implement best
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 nationwide.
(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 delivery to
improve the quality and value of health care.
SEC. 3. IMPLEMENTATION OF BEST PRACTICES TO IMPROVE 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 following:
``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 national
priorities and goals for quality improvement in the 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
recommending national quality improvement targets. Such group shall
include representatives of the various interests and organizations
needed to enable change, including consumers, physicians, nurses,
hospitals and other care delivery organizations, non-Federal purchasers
of care, health care oversight or accrediting bodies, research
organizations, and entities with successful experience in quality
improvement 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, effectiveness, patient-centeredness,
timeliness, efficiency, and equity.
``(c) Periodic Updates of National Priorities and Goals.--The
Secretary shall update the national priorities 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 in the delivery of health care services in the United
States, including through the work of the Center for Health Extension
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 include representatives from the
Agency for Healthcare Research and Quality, including the Center for
Health Extension established under section 942, the National Institutes
of Health, the Centers for Disease Control and Prevention, the Centers
for Medicare and Medicaid Services, the Health Resources and Services
Administration, the Indian Health Service, the Department of Defense,
the Veterans Health Administration, and other agencies the Secretary
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 establish within the
Agency for Healthcare Quality and Research 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 improve 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 practices.--The Center
shall identify and develop clinical, managerial, and health
care delivery best practices for implementation in quality
improvement activities.
``(2) Assist with the implementation of best practices.--
The Center shall provide voluntary training and technical
assistance to hospitals, other health care facilities, and
clinician practices to assist with the implementation of best
practices.
``(3) Measure patient outcomes and satisfaction.--The
Center shall provide for the measurement of patient outcomes
and satisfaction, before, during, and after implementation of
quality improvement activities.
``(4) Evaluate effectiveness of activities.--The Center
shall evaluate the effectiveness of quality improvement
activities, and progress improving patient outcomes.
``(c) Identification of Best Practices.--
``(1) In general.--The Center shall provide for the
identification of highly effective clinical, managerial, and
health care delivery practices and innovations 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 Center 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 hospitals, health care facilities,
clinician practices, community cooperatives, and other
health care entities.
``(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 innovations 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, managerial, and
health care delivery practices, taking into account the
requirements described in paragraph (2).
``(2) Requirements.--Practices developed under paragraph
(1) shall--
``(A) be supported by empirical evidence showing
that they have a high likelihood of improving patient
outcomes and satisfaction;
``(B) be specified with sufficient detail of the
individual processes, steps, training, skills, and
knowledge required for implementation and incorporation
into workflow of health care practitioners 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 Secretary
(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 demonstration of
meaningful use of certified Electronic Medical Record
technology by physicians and hospitals under the
Medicare program (under sections 1842(o)(2) and
1886(n)(3), respectively, 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 improving the
care and patient outcomes.
``(3) Collaboration with health care providers and other
entities.--The Center may collaborate with health care
providers and other entities to foster the development of
highly effective 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 delivery design as described in
section 943(g).
``(5) Ongoing review and improvement.--The Center shall
provide for regular review, updating, and improvement of
practices developed under this subsection.
``(e) Training and Education for Health Care Providers.--
``(1) In general.--Acting through the Regional 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;
``(B) have the greatest impact on patient outcomes
and satisfaction; and
``(C) are determined to be readily employable in
health care settings.
``(2) Technical assistance.--The Center shall work through
the Extension Centers to carry out the following functions:
``(A) Establishment of participation.--The
Extension Centers shall seek the voluntary
participation of hospitals, health facilities, and
clinician practices in a region to enter into
arrangements to receive assistance in implementing
highly effective practices identified under subsection
(c) or developed under subsection (d). Hospitals,
health facilities, and clinician practices entering
into such arrangements are hereinafter referred to in
this subsection 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 administrative staff who are
responsible for the implementation of the quality
improvement activity or initiative.
``(C) Assessment of existing practices.--The
Extension Centers shall conduct an assessment of the
existing practices as compared to the identified highly
effective practice at each hospital, facility, or
practice that participates in an arrangement under this
subsection.
``(D) Development of implementation plan.--Each
collaborating provider shall work with the Extension
Center to develop an implementation plan for the
incorporation of the highly effective practice into the
care of the provider.
``(E) Training for collaborating providers.--Staff
of the Extension Center shall work with the
collaborating providers to execute the implementation
plan. Such staff shall provide 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.--Pursuant to a data
protection agreement entered into between the Extension
Center and the collaborating provider, the Extension
Center shall collect data to measure best practice
implementation and patient outcomes before, during, and
after implementation of quality improvement activities
using, to the extent practicable, data already reported
for other purposes by collaborating providers. Where
applicable, the Extension Center shall also collect
data to measure the culture of safety.
``(G) Timely feedback to collaborating providers.--
The Extension Center shall provide to each
collaborating provider--
``(i) analysis conducted by the Extension
Center on the collaborating provider's progress
implementing the highly effective practice and
improving patient outcomes, and, where
applicable, improving the culture 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.
``(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 collaborating providers.
``(I) Meetings.--The Extension Center shall provide
for meetings of panels of collaborating providers
working with Extension Centers on similar quality
improvement activities for the purpose of reciprocal
learning and information exchange.
``(J) Coordination with other quality improvement
entities.--If an Extension Center is not the
organization holding a contract 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
Center 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 activities.--The Center
shall immediately prioritize assistance 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 infections,
including reducing catheter-associated urinary tract
infection, ventilator-associated pneumonia, and central
line-associated bloodstream 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, including 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 neonatal care,
including the appropriate use of cesarean sections, and
the implementation of best practices for labor and
delivery care.
``(E) Care transitions.--Transitions of patients
between settings, including reduction of unnecessary
hospital readmissions and increased coordination
between teams of unaffiliated 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 activities 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 Extension Center's
activities on patient outcomes and satisfaction, including
lives saved, and cost savings attributable 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 information on the aggregate progress implementing
highly effective practices, the aggregate impact of the
Extension Centers' activities on patient outcomes 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 additional information as the Center may specify.
``(3) Evaluation of effectiveness.--To the extent
practicable, the Center shall evaluate the effect of
implementing individual best practices on improving 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 engineering, rapid design
laboratories, cognitive and social psychology studies,
materials sciences, and statistics.
``(2) Examples of activities to be conducted.--Health care
delivery design activities conducted 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;
``(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 improve
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 patient care and satisfaction.
``(4) Requirements.--The health care delivery design
improvement activities conducted under this paragraph shall--
``(A) be based on identified need for improvement
in a specific area of health care delivery;
``(B) aim to discover or develop designs that can
be readily adopted by health care providers and
facilities;
``(C) aim to improve patient outcomes and
satisfaction;
``(D) where applicable, be designed to be
consistent with standards adopted by the Director
(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 demonstration of
meaningful use of certified Electronic Medical Record
technology by physicians and hospitals under the
Medicare program (under sections 1842(o)(2) and
1886(n)(3), respectively, 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 improving the
care and patient outcomes.
``(h) Research and Related Activities.--The Center shall conduct or
fund research and other knowledge generation activities on the factors
that facilitate behavior change for the sustainable integration of
highly effective and innovative practices into medical practice and on
the factors that foster an environment of continual improvement.
``(i) Public Dissemination of Information.--The Center shall
provide for the public dissemination of objective information with
respect to activities and research conducted under this Act. Such
information shall be made available through multiple media and
appropriate formats to reflect the varying needs of consumers and
diverse levels of health literacy.
``(j) Reports.--
``(1) Annual reports.--Not later than April 1 of each year,
beginning in 2011, the Director of the Center shall submit a
report to the Secretary on the activities of the Center and the
Extension Centers during the preceding year.
``(2) Content.--Each report submitted under paragraph (1)
shall include information on--
``(A) the number of arrangements established by
Extension Centers with collaborating providers;
``(B) the progress made accelerating the
implementation of best practices by the collaborating
providers during the year involved and for such other
years as the Director determines to be appropriate;
``(C) the level of implementation of best practices
at collaborating providers as compared to other
providers;
``(D) the impact of the work of each Extension
Center on patient outcomes and patient safety,
including lives saved, and cost savings attributable to
the activity or initiatives of the Extension Center;
``(E) the aggregate national impact of the work of
the Center and Extension Centers on patient outcomes
and patient safety, including lives saved, and cost
savings attributable to the activity or initiatives of
the Extension Centers and the Center, including cost
savings to Medicare and Medicaid;
``(F) progress made toward the national goals for
health care quality improvement, as established under
secton 941;
``(G) evaluations of the impact of implementing
individual best practices on patient outcomes and
satisfaction, to the extent such analysis is
practicable;
``(H) research and other related activities
conducted or funded by the Center during the year
involved and the results of those efforts in improving
patient safety and the quality of care in the delivery
of health care services or in the science of
improvement; and
``(I) such other matters as the Center, or the
Secretary, determines to be appropriate.
``(3) Public availability.--The Secretary shall transmit
each report under this subsection to Congress and shall make
each such report available to the public.
``SEC. 944. REGIONAL HEALTH EXTENSION CENTERS.
``(a) Establishment of Regional Health Extension Centers.--The
Center shall establish, either directly or through contracts with
qualified entities (as defined in subsection (b)), Regional Health
Extension Centers (referred to in this Act as `Extension Centers') to
carry out the functions described in section 943(e) within such States
or regions as the Center determines to be appropriate:
``(b) Definition.--In this section, the term `qualified entity'
means an entity that meets all of the following requirements:
``(1) Demonstrated experience.--The entity has experience--
``(A) in carrying out the type of functions
described in section 942(e);
``(B) in operating programs on a statewide,
regionwide, or nationwide basis to improve patient
safety and the quality of health care delivered in
health care settings; and
``(C) in working with a variety of institutional
health care providers, physicians and other health care
practitioners.
``(2) Nonprofit organization.--The entity is a nonprofit
entity organized for charitable purposes under section 501(c)
of the Internal Revenue Code of 1986.
``(3) Governance.--The entity is governed by a board that
includes representatives of multiple health care and nonhealth
care stakeholders (including consumers), such that
representatives of no single stakeholder group constitute a
majority.
``(4) Entities with other existing contracts.--The
performance of services under this act shall be deemed not to
create a conflict of interest under other existing Federal
contracts for quality improvement, health information
technology technical assistance, or data aggregation.
``(5) Audits.--The Extension Centers shall be subject to
periodic audit.
``SEC. 945. FUNDING.
``For the purpose of carrying out this part, there is authorized to
be appropriated $200,000,000 for each of the fiscal years 2010 through
2014.''.
<all>
Introduced in House
Introduced in House
Referred to the House Committee on Energy and Commerce.
Referred to the Subcommittee on Health.
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