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Medicare Independence at Home Medical Practice Demonstration Improvement Act of 2015

Floor Speech

Location: Washington, DC


Mr. ROSKAM. Mr. Speaker, I thank Chairman Ryan for yielding time.

I am pleased to see that we are taking up this 2-year extension of the independence at home demonstration project, which expired on May 1.

I first got interested in this because of a constituent, Dr. Thomas Cornwell from Wheaton, Illinois. He is actually a visionary. He was way ahead of his time on this effort to reach out to patients at home. He is the president of the American Academy of Home Care Physicians and chairman and chief medical officer of the Home Centered Care Institute. He has been really passionate about this idea of trying to reach people where they are.

Since the founding of his home care practice in 1997, Mr. Speaker, he has personally made over 30,000 house calls. So he knows intimately the difference that a home care option makes in the lives of individuals with multiple chronic conditions and the savings that it can bring to the healthcare system to treat these people at home rather than at the hospital.

So what he has been able to do is to say, look, this is better for the patient and it is better for the system, so let's pursue this and let's move it further along. That is exactly what the independence at home demonstration brings to Medicare. It focuses on reducing costs where the needs are the highest and improving care where the needs are the greatest. It provides home-based care to medical enrollees with two or more chronic conditions who are within the 5 to 25 percent of beneficiaries that account for nearly 80 percent of all Medicare spending.

Of the 34 Medicare home care demonstrations over the past 20 years, the IAH is decidedly different, requiring that doctors meet fiscally responsible conditions of participation. Here is what they have got to do: they have to return a minimum savings of at least 5 percent to Medicare; they have to produce good outcomes; and they have to pass patient and caregiver satisfaction ratings.

It even provides an additional incentive by allowing successful patient participants to share in any savings that generate from Medicare above that 5 percent mark on an 80/20 basis. So think about that; everybody comes out ahead on this. And it is working.

In June, CMS reported that IAH saved over $25 million in its first performance year. That is an average of over $3,000 for each of the 8,400 beneficiaries that participated in the demonstration.

In other words, have you heard, have you talked about, have you contemplated anything that is like this? In other words, you have got happier patients, and they are saving money at $3,000 a person. What is not to love about this?

We have several lessons from this that have been artfully crafted into the demonstration itself. It requires participants to save taxpayer money by avoiding unnecessary hospitalizations, ER visits, and nursing home admissions.

It protects the viability of the Medicare Program, provides quality health care for those most in need, and benefits providers by giving them the flexibility they need to care for their patients and share in the savings they produce.

For those reasons, I strongly support passage of this, and I thank Chairman Ryan for his support.


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