By Mike Lillis - 06/29/10 11:45 PM EDT
Two Democratic sponsors of a popular program to treat the nation’s frailest seniors in their own homes are pushing the White House for a quicker launch.
The so-called Independence at Home (IAH) program, included as part of the Democrats’ new health reform law, is scheduled to take effect no later than Jan. 1, 2012, but Sen. Ron Wyden (D-Ore.) and Rep. Edward Markey
(D-Mass.) warn that waiting that long would threaten the health of one of the country’s most vulnerable populations.
“It is well-established that Medicare beneficiaries with multiple chronic diseases — the same population served by the IAH program — receive poor quality and unnecessarily costly, disjointed care,” the lawmakers wrote Tuesday to Marilyn Tavenner, CMS’s acting administrator. “Implementation of the IAH program as soon as possible would appear to us to be clearly in the best interests of the frail, chronically ill Medicare beneficiaries eligible to participate.”
While quick implementation of the program could be good policy, there is also a political element to the push.
With many seniors wary of the Medicare cuts contained in the Democrats’ new health reform law, party leaders are eager to prove that those cuts won’t harm the quality of care.
“We can have higher quality at lower cost,” said Thomas Edes, president of the American Academy of Home Care Physicians (AAHCP).
Edes, who is also the director of home care at the Department of Veterans Affairs (VA), said a similar home care program operated for decades at the VA has reduced hospital admissions by 25 percent, hospital days by 36 percent and healthcare costs by 15 percent.
The IAH program, enacted as a three-year demonstration project, encourages teams of doctors and nurse practitioners to make house calls to seniors whose multiple chronic conditions make travel to hospitals and doctors’ offices difficult. The primary care program is designed to target the most vulnerable — and most expensive — of all Medicare patients. Indeed, the sickest 5 percent of Medicare patients account for more than 40 percent of the program’s costs.
“If we don’t start there, how are we going to bend the [cost] curve?” Suzanne Mintz, head of the National Family Caregivers Association, said Tuesday during a Capitol Hill gathering to celebrate the passage of the IAH provision.
Primary care, under the program, is coordinated to meet individual chronic needs, and providers must reduce healthcare costs by at least 5 percent to be paid by Medicare. Supporters maintain that the savings will be significant by reducing the number of visits to emergency rooms and other expensive acute care settings.
The savings is then divided between Medicare and the providers, creating incentives for doctors to participate at no additional cost to taxpayers. George Taler, a physician at the Washington Hospital Center, said Tuesday that the model marks a wise step away from the fee-for-service system that has practically defined Medicare for decades.
“In the current system, the more we do, the more we get paid. And so we do more,” said Taler, an AAHCP board member. Under the home care model, he added, “we earn money by saving money. That is truly a different system of care.”
The law gives CMS $5 million to administer the program this year, and an additional $5 million each year through 2015. The Congressional Budget Office estimates that the savings to Medicare generated by the program will offset the $30 million administrative costs.
“This is the future of chronic care,” Wyden said Tuesday.
Wyden and Markey also pressed CMS to extend the program beyond three years and to include at least 5,500 seniors in the demonstration.
It was CMS that, leery of potential complications surrounding implementation, had pushed lawmakers to delay the required launch of the IAH program until 2012. A CMS spokesperson said that officials “have begun developing an implementation plan and timeline for the demonstration,” which they’ll launch “as quickly as possible.” The agency is also reviewing the VA’s home care program “for any lessons learned,” the spokesperson said in an e-mail.
Supporters of the IAH, though, insist that CMS has all the tools it needs to launch the program soon. “We’ve given them the specifications; we’ve given them the money,” said Jim Pyles, board member of AAHCP. “We’re ready to go.”