Wyden, Markey Encourage CMS to Implement Their “Independence At Home” Program Within 6 Months
IAH Program Included in Health Care Reform Law, Sponsors Receive Award from American Academy of Home Care Physicians
WASHINGTON, D.C. – U.S. Senator Ron Wyden (D-Ore.) and Representative Edward J. Markey (D-Mass.), authors of the Independence at Home demonstration program included as Section 3024 of the Patient Protection and Affordable Care Act (P.L. 111-148), today sent a letter to Acting CMS Administrator Marilyn Tavenner encouraging CMS to implement the program as soon as possible prior to the law’s January 2012 deadline, with a goal of implementation within the next 6 months. This morning, Wyden and Markey also received an award from the American Academy of Home Care Physicians at a ceremony kicking off “Independence at Home Day” on Capitol Hill.
The Independence at Home program enables Medicare beneficiaries with multiple chronic conditions, such as Alzheimer’s Disease, diabetes, congestive heart failure and other permanent conditions, to maximize their independence by bringing primary care to them in their homes furnished by physician and nurse practitioner directed teams of health care professionals tailored to the beneficiaries’ specific chronic conditions Individuals with multiple chronic diseases account for up to 85 percent of Medicare spending and typically suffer poorly managed, disjointed care under the current highly fragmented, fee-for-service, traditional Medicare reimbursement system.
“We believe strongly that there are numerous reasons for implementing the IAH program sooner rather than later,” the lawmakers wrote in the letter. “There is also strong evidence that the clinical house call model at the heart of the IAH program works and can be implemented quickly.”
In the letter, the lawmakers also:
- Suggest that CMS enter into agreements with a sufficient number of IAH health providers so that at least 5,500 Medicare beneficiaries participate to ensure that the demonstration program is adequately tested.
- Recommend that the implementing specifications for the IAH demonstration program provide for an 80 percent/ 20 percent split of savings for providers beyond the first 5 percent savings threshold during the 3-year term of the IAH demonstration, as long as providers meet certain quality of care requirements. Such a division of savings is intended to address the economic risk providers assume to participate in the IAH demonstration program, as providers are accountable for achieving at least 5 percent savings for caring for Medicare beneficiaries participating in the IAH program as compared to the cost of caring for these patients in the absence of the IAH program.
- Call for CMS to expand the IAH program beyond 3 years to include additional beneficiaries if it is saves money and improves care.
A copy of the letter can be found here:
The full text of the Independence at Home program in the Patient Protection and Affordable Care Act follows:
: H. R. 3590—286
SEC. 3024. INDEPENDENCE AT HOME DEMONSTRATION PROGRAM.
Title XVIII of the Social Security Act is amended by inserting after section 1866D, as inserted by section 3023, the following new section:
‘‘INDEPENDENCE AT HOME MEDICAL PRACTICE DEMONSTRATION
PROGRAM
‘‘SEC. 1866D. (a) ESTABLISHMENT.—
‘‘(1) IN GENERAL.—The Secretary shall conduct a demonstration program (in this section referred to as the ‘demonstration program’) to test a payment incentive and service
delivery model that utilizes physician and nurse practitioner directed home-based primary care teams designed to reduce expenditures and improve health outcomes in the provision
of items and services under this title to applicable beneficiaries(as defined in subsection (d)).
‘‘(2) REQUIREMENT.—The demonstration program shall test whether a model described in paragraph (1), which is accountable for providing comprehensive, coordinated, continuous, and
accessible care to high-need populations at home and coordinating health care across all treatment settings, results in—
‘‘(A) reducing preventable hospitalizations;
‘‘(B) preventing hospital readmissions;
‘‘(C) reducing emergency room visits;
‘‘(D) improving health outcomes commensurate with the beneficiaries’ stage of chronic illness;
‘‘(E) improving the efficiency of care, such as by reducing duplicative diagnostic and laboratory tests;
‘‘(F) reducing the cost of health care services covered under this title; and
‘‘(G) achieving beneficiary and family caregiver satisfaction.
‘‘(b) INDEPENDENCE AT HOME MEDICAL PRACTICE.—
‘‘(1) INDEPENDENCE AT HOME MEDICAL PRACTICE DEFINED.—
In this section:
‘‘(A) IN GENERAL.—The term ‘independence at home medical practice’ means a legal entity that—
‘‘(i) is comprised of an individual physician or nurse practitioner or group of physicians and nurse practitioners that provides care as part of a team that includes physicians, nurses, physician assistants, pharmacists, and other health and social services staff as appropriate who have experience providing home-based primary care to applicable beneficiaries, make in-home
visits, and are available 24 hours per day, 7 days per week to carry out plans of care that are tailored to the individual beneficiary’s chronic conditions and designed to achieve the results in subsection (a);
‘‘(ii) is organized at least in part for the purpose of providing physicians’ services;
‘‘(iii) has documented experience in providing home-based primary care services to high-cost chronically ill beneficiaries, as determined appropriate by the Secretary;
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