Launch Medicare home care pilot project soon, lawmakers tell CMS

The Independence at Home demonstration is scheduled to begin in 2012, but two congressional Democrats want to see it start within six months.

By David Glendinning, amednews staff. Posted July 13, 2010.

Washington -- A Medicare demonstration project that will test whether chronically ill beneficiaries will benefit by receiving coordinated primary care in their homes should be implemented more quickly, a pair of lawmakers told the Centers for Medicare & Medicaid Services.

In a June 29 letter to Marilyn Tavenner, then acting administrator for CMS, Sen. Ron Wyden (D, Ore.) and Rep. Edward Markey (D, Mass.) said the Independence at Home demonstration should be up and running within six months. The national health reform law enacted in March mandated the demo, but it set the implementation deadline for January 2012.

"We believe strongly that there are numerous reasons for implementing the IAH program sooner rather than later," the lawmakers wrote. "There is also strong evidence that the clinical house call model at the heart of the IAH program works and can be implemented quickly."

Independence at Home seeks to determine whether providing home-based primary care services to Medicare enrollees with multiple chronic conditions will improve patient outcomes and save the program money through decreased hospitalizations and emergency department visits. Under the demonstration, physicians and nurse practitioners will direct teams of health professionals to coordinate primary home care. If they are able to reduce Medicare costs by at least 5% compared with more traditional office- and hospital-based care, the teams will receive a share of any savings beyond that threshold.

Wyden and Markey also requested that CMS:

Specify that home care physicians and other health care professionals receive 80% of any savings beyond 5%, as an added incentive for them to participate.
Negotiate enough Independence at Home agreements with health care professionals to ensure that at least 5,500 chronically ill Medicare beneficiaries can participate.
Allow Medicare beneficiaries who have received Medicare home health services within the past year to take part in Independence at Home.
Expand the demonstration program beyond its three-year run if it proves to lower Medicare costs and improve patient outcomes.

The American Academy of Home Care Physicians, the American Academy of Nurse Practitioners and the American Nurses Assn. are among the groups that support the Independence at Home project.

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