CMS today announced the selection of practices and programs to participate in the Independence at Home Demonstration program. This program, with legislation authored by Senator Ron Wyden (D-Ore.) and Congressman Ed Markey (D-Mass.), was authorized in Section 3024 of the Accountable Care Act. It will start the process of bringing home-based primary care to some of Medicare's sickest and most frail seniors who cannot access office or clinic-based care. This program is a triple win: it allows seniors greater independence while providing greater access to primary care, improving quality, and reducing cost. The cost savings come from reducing or eliminating unneeded ER visit, inpatient hospitalization or nursing home placements rather than by cutting coverage, or reimbursement or shifting costs sick to the sick and disabled.

 

The IAH design guarantees minimum savings to Medicare and Medicaid of 5% annually on the highest cost beneficiaries as a condition of participation. Programs are responsible not only for medical care, but for comprehensive medical and social services care coordination, and for meeting defined quality standards and reporting patient/caregiver satisfaction. Programs that meet required savings and quality thresholds are eligible for shared savings to help pay for the additional personnel and technology costs of operating the IAH program. Other Medicare providers may also share in those savings.

 

The program is similar to one that has operated in the VA for decades and currently serves over 27,000 veterans.  It and similar programs operating in private practice, managed care, academic medical centers and integrated health systems have shown savings in the range of 24-60% by moving the care of these chronically ill patients from high cost institutions into the lower cost setting of the home.  It is estimated that only ¼ of seniors who could benefit from this kind of care currently receive it. The demonstration is capped at 10,000 beneficiaries.  Additional programs participating in the consortium model option will be announced sometime after their applications are received May 4. 

 

The American Academy of Home Care Physicians has received a grant from The Retirement Research Foundation to operate a Learning Collaborative to support the Demonstration's success.

 

Said Dr. Bruce Leff, President of the American Academy of Home Care Physicians, the thought leaders behind the legislation, "the AAHCP is pleased that CMS has approved the initial round of IAH applicants. We believe that this model of care holds great promise for some of Medicare's least well served beneficiaries, offering better care at lower costs. However, we are also saddened that CMS was forced to turn down so many worthy applicants because of the 10,000 beneficiary cap in the current Demonstration. We pledge to work to lift that cap so that more of Medicare's sickest seniors can be served by qualified programs and practices."

 

 Said IAH legislative authors Congressman Markey and Senator Wyden:

 

"Through Independence at Home, our most vulnerable seniors can receive care in their living room rather than an emergency room," said Rep. Markey. "Independence at Home will transform the broken and fragmented way our sickest and most vulnerable seniors receive care today. All this is made possible by the fact that, for the first time, the doctors and nurses caring for these patients will be able to share in the savings that result from their good work. Independence at Home will help steer our health care system toward a focus on quality and not simply the quantity of care. We will continue to work with our colleagues and CMS to make the Independence at Home program accessible to all Medicare beneficiaries and their family caregivers in the future." - Congressman Edward Markey

 

"If fully realized, the Independence at Home program has the potential to save the Medicare system billions. Today's announcement is a milestone moment but there is still work to do. With only 10,000 patients in the pilot program it will take time for the program to reach that potential, but I am confident that when people see the benefits of providing better care for patients at lower cost in their homes the program will only grow. And for the thousands of patients and hundreds of providers that will benefit from cost-effective home-based care, today's announcement is great news." - Senator Ron Wyden

 

The list of approved IAH Demonstration practices is below:

• Boston Medical Center (Boston, Massachusetts)
• Christiana Care Health Services (Wilmington, Delaware)
• Cleveland Clinic Home Care Services: Medical Care at Home Program (Independence, Ohio)
• Comprehensive Geriatric Medicine P.C. (Brooklyn, New York)
• Doctors Making Housecalls, LLC (Durham, North Carolina)
• Housecall Providers, Inc. (Portland, Oregon)
• MD2U (Louisville, Kentucky)
• National House Call Practitioners Group (Austin, Texas)
• North Shore - Long Island Jewish Health Care Inc.: Physician House Calls Program (Westbury, New York)
• RMED, LLC (Jacksonville, Florida)
• Visiting Nurse Housecall, LLC (Atlanta, Georgia)
• Visiting Physicians Association, P.C. - Flint/Saginaw/Marysville (Flint, Michigan)
• Visiting Physicians Association, P.C. - Lansing/Ann Arbor (Okemos, Michigan)
• Visiting Physicians Association, P.C. - Milwaukee (West Allis, Wisconsin)
• Visiting Physicians Association of Texas, PLLC - Dallas (Irving, Texas)
• Wellness Resources Network, LLC (Sunrise, Florida)

For more information about IAH, go to www.IAHNow.com. For more information on the Academy, go to www.aahcp.org.