Is the Administration Leaving a Promising Health Reform In the Cold?

When the Veterans Affairs Department implemented a program to provide home-based health care to veterans with multiple chronic conditions — many of the system’s most expensive patients to treat — they received astounding results. The amount of hospital stays for the veterans participating in the program went down by 62 percent and the number of nursing home days went down by 88 percent. In total, the cost of providing healthcare to these chronically ill patients shrunk by nearly 25 percent.

The University of Pennsylvania Medical Center found that a similar program instituted for a segment of the sickest Medicaid beneficiaries had similar results and not only saved Medicaid 23 percent of the cost of caring for these patients, it increased the survival rate for this group by 46 percent.

How do these programs realize such savings? By doing a better job of caring for patients with multiple, chronic and often debilitating diseases. These are patients who regularly see multiple doctors and are in and out of emergency rooms and assisted living facilities. Instead of leaving these patients to fend for themselves, these programs send health care providers to their homes to check vital signs, organize pill bottles and coordinate the patient’s overall care.

Patients who have participated in these programs are healthier, spend less time in doctor’s offices and are more able to continue aging in their own homes without burdening loved ones. And all of that saves the system money because it costs less to keep a patient healthy than it does to treat them only when they are sick.

Given these results, Congressman Ed Markey and I thought it only made sense to create a version of the program for Medicare beneficiaries. After all, Medicare recipients with multiple chronic illnesses 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. If a home-based Medicare program realized even just a fraction of the other programs’ success, Medicare could save a lot of money (potentially billions) while improving health outcomes for millions of seniors.

Congressman Markey and I introduced what we called “Independence at Home” (IAH) in 2008 and we passed it into law with the help of Senate Finance Committee Chairman, Max Baucus, who included it in his committee’s mark of the health care law signed last year. While much of the Affordable Care Act doesn’t take effect until 2014, the IAH program is scheduled to start in January 2012 as a demonstration project for 10,000 seniors.

However, as Congress and the administration have scrambled to find new ways of saving Medicare money, we’ve pointed out that there is no reason Independence at Home has to start as a demonstration project. Thanks to the Veterans Affairs program and the University of Pennsylvania study, there is already demonstrable evidence that home health programs work.

So, instead of looking for ways to cut Medicare programs and benefits, why not save Medicare money by looking for ways to skip the demonstration project and expand the Independence at Home to millions of seniors from the start? It would make sense, right?

Apparently not. Because not only isn’t the administration not looking for ways to expand Independence at Home, they aren’t even taking the steps necessarily to launch the demonstration project.

While the law says that the IAH demonstration program needs to begin next month, the Center for Medicare and Medicaid Services (CMS) — the federal agency tasked with putting this program into effect — has yet to release guidelines for healthcare providers to sign up for the program. These guidelines were supposed to be issued months ago. Without them, providers can’t apply to be a part of the program. And with only weeks left before the demonstration project is supposed to start, no one is signed up to take part.

In other words, Independence at Home is being set up to fail.

Last week, Rep. Markey and I sent a letter to the new Acting CMS director Marilynn Tavenner asking her to release these guidelines as soon as possible so that the program can get underway. It is our hope that with new leadership CMS will finally recognize the potential benefits of providing homes care for Medicare beneficiaries. It would be great if we could launch this program for millions of chronically ill seniors from the start, but at the very minimum, CMS should follow the law and launch the IAH demonstration program as the Affordable Care Act — which the president signed — requires. Seniors deserve more than cuts, they deserve an opportunity to reap the benefits of this proven approach.