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On Oct. 13, 2009, the Senate Finance Committee approved Chairman Max Baucus’ healthcare reform legislation, the America’s Healthy Future Act of 2009 (the Bill). The Bill has advanced to conference where it will be merged with other proposed healthcare reform legislation. Of considerable significance to the home health industry, the final text of the Bill included an “Independence at Home” amendment written by Sen. Ron Wyden, a co-sponsor of the Independence at Home Act of 2009 (the IAH Act, H.R. 2560/S. 1131), which was introduced in Congress last spring.
The Independence at Home Amendment would create a pilot program utilizing interdisciplinary teams of healthcare professionals to care for patients with multiple chronic conditions in their homes. The program would bring primary care services directly to the patient, and provide care in a consistent, coordinated manner with the goal of reducing duplicative, fragmented and unnecessary services.
According to Sen. Wyden, patients with multiple chronic conditions comprise less than a quarter of Medicare beneficiaries, but account for 66 to 85 percent of Medicare spending, 76 percent of all hospital admissions, 88 percent of all prescriptions filled and 72 percent of physician visits. The Independence at Home Amendment is intended to generate a cost savings by reducing the number of emergency room visits and unnecessary hospitalizations involving these patients. Studies cited in the IAH Act demonstrate that the use of interdisciplinary teams of healthcare professionals caring for patients with multiple chronic conditions in their places of residence achieved reductions in hospital utilization resulting in significant cost-savings.
The Independence at Home Amendment also creates incentives for providers to develop better and lower cost healthcare for the highest cost beneficiaries by offering shared-savings eligibility to those healthcare providers who achieve quality outcomes.
If the Bill is adopted, the Independence at Home program will be implemented through a pilot program based on the successful house calls programs operated by the Veteran’s Administration and other providers across the country. The Secretary of Health and Human Services will have authority to select the participants in the pilot program so as to cap the number of applicable Medicare beneficiaries at 10,000. Agencies that would like to participate in the pilot program would be required to have a minimum of 200 Medicare beneficiaries with multiple chronic conditions. Agencies can join together into larger groups to meet this requirement.
The inclusion of the Independence at Home Amendment in the Bill revitalizes the home-based chronic care management pilot program concept first introduced in the IAH Act, which has been languishing in committee in both the House and Senate since May 2009. According to a press release from Sen. Wyden issued on May 21, 2009, individuals eligible for the IAH Act pilot program would include Medicare beneficiaries with functional impairments, two or more chronic health problems, and recent use of other health services. Each Independence at Home (IAH) patient would receive a comprehensive assessment at least annually. Further, the IAH interdisciplinary team of providers would be required to demonstrate savings of at least 5 percent annually compared with the costs of serving non-participating Medicare chronically ill beneficiaries, and the IAH providers could keep 80 percent of savings beyond the required 5 percent savings as an incentive to maximize the financial benefits of being an IAH provider. Any savings beyond 25 percent would be shared with 50 percent directed to the IAH provider and 50 percent to Medicare.
Waller Lansden’s Healthcare practice will follow the Bill’s progress and, in particular, developments related to the Independence at Home Amendment to assist home care providers in understanding and responding to the Bill’s impact on their industry. For more information, please contact Stephen L. Page, W. Kenneth Marlow, Bethany Kolenic or any member of the Waller Lansden Healthcare practice at 800-487-6380.
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