December 07, 2011

Wyden, Markey Call on CMS to Release Guidelines for Program That Experts Say Could Result in Substantial Medicare Savings by Better Coordinating Care

Pilot Program is Supposed to Launch in 2012, But Guidelines Have Yet to Be Issued

Washington, D.C. – A program providing home-based health care for the most chronically-ill veterans, saved the Veterans' Affairs Department more than 24 percent on the overall cost of caring for those patients, yet a similar program scheduled to be tested as part of Medicare has largely gone ignored by the Centers for Medicare and Medicaid Services (CMS).

The Independence at Home pilot program -- originally authored by U.S. Senator Ron Wyden (D-Ore.) and U.S. Representative Edward J. Markey (D-Mass.) and passed into law as part of the Affordable Care Act -- is supposed to start in three weeks, yet CMS has yet to issue guidelines for the program making it impossible for interested providers to sign up to take part. Wyden and Markey today sent a letter to the new Acting CMS Administrator Marilyn Tavenner urging CMS to release guidelines as soon as possible.

Wyden and Markey have been pressing the administration to expand eligibility for the Independence at Home program in order to maximize its potential for Medicare savings, but as they state in their letter failure to give health care providers adequate time to sign up would set even the pilot program up for failure.

“This would be a disastrous outcome given that IAH utilizes a proven delivery model, which has been shown to dramatically improve patient care and satisfaction while significantly reducing costs for chronically ill individuals,” Wyden and Markey wrote in the letter.

A copy of the letter to CMS can be found HERE.

The Independence at Home pilot program will provide high quality home care for roughly 10,000 of the millions of Medicare patients suffering from multiple chronic diseases. Beneficiaries in this group are among the highest-cost segment of the entire Medicare population -- making up roughly 5-8 percent of beneficiaries but accounting for more than 50 percent of total Medicare costs -- because they suffer from multiple and costly chronic illnesses. As demonstrated by the VA program, better coordinating care for this group of patients not only results in better patient care, but substantial system wide savings. The VA program, for example, reduced costly hospital stays by 62 percent, nursing home days by 88 percent and overall costs by 24 percent.

Experts have argued that if applied to the entire Medicare population with multiple chronic conditions, an IAH program can result in significant savings and better health outcomes.

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