We have exciting news about a new demonstration project the government is doing to evaluate the benefits of home-based care! The new Acting Administrator for the Centers for Medicare & Medicaid Services (CMS), Marilyn Tavenner, has a medical background where she has seen first-hand the benefits of homecare.  She is spearheading a 3-year project, called Independence at Home, where CMS can explore how timely in-home primary care can “prevent such (emergency department) visits and inpatient hospitalizations by bringing clinical expertise and mobile technology into the home when clinical instability is first developing”.

As such, CMS is looking to “assess the effects of timely, in-home primary care on health costs, quality of care, and rates of preventable hospitalizations, hospital readmissions, and (emergency department) visits.”  Up to 10,000 Medicare beneficiaries will be able to receive their primary care in-home through this demonstration project.

This project will focus on Medicare’s frailest and sickest beneficiaries who are at greatest risk of complications due to a lack of access to routine primary care.  These Medicare patients, who represent about 5-8% of all Medicare beneficiaries, consume approximately 50% of all Medicare health costs. The demonstration project goal will be to provide them with “timely and appropriate care” to help address issues as soon as they begin developing, keeping them healthier and at home where they prefer to be.  According to CMS, participating beneficiaries will benefit through increased access to care and improved patient satisfaction.

For a Medicare patient to qualify for Independence at Home Demonstration, he/she must have the following criteria:

• Entitled to receive Part A and enrolled to receive Part B of Medicare benefits (not Part C or in PACE)
• Have 2 or more chronic conditions (medical conditions that last more than one year, limit what one can do, and requires ongoing medical monitoring)
• Have 2 or more functional impairments that require human assistance to perform activities of daily living (bathing, dressing, transferring, walking, toileting, or eating).
• Have previously had a hospitalization or use of rehab or post-acute care 12 months prior to starting the program.

If your medical provider chooses to participate in Independence at Home, you will be notified by them prior to the implementation of the project.  Voluntary beneficiary participation is automatic if you elect to have home services by a participating provider.  What a great opportunity to benefit from an expanded homecare program and receive all of your needed medical services from the convenience and comfort of home.  Should you need to be admitted to the hospital or visit the emergency room, your participating provider will contact you to check out how you’re doing and then within 48 hours of being discharged to establish a follow-up plan of care.

This program offers a payment incentive to participating medical providers if they successfully meet certain quality measures, have 200 or more eligible Medicare patients, and comply with eligibility requirements.  For example, the practice must make in-home primary care visits and use electronic health records, remote monitoring, and mobile diagnostic technology.  They will be available 24/7 to implement the individualized care plans for participating patients and will comply with all state and federal privacy laws.  50 entities will be selected for this program, and once enrolled, they will remain in the program for the duration of the 3-year demonstration project.

Study after study show the benefits of homecare, including faster healing times, reduced readmissions, and higher patient satisfaction.  We’re optimistic about the Independence at Home Demonstration and the credibility it will bring to homecare as a viable alternative to our current methods for providing health care.   Click here to learn more about the Independence at Home Demonstration and to read CMS’ press release.

In the words of Acting Administrator Marilyn Tavenner , “This program gives new life to the old practices of house calls, but with 21st Century technology and a team approach.  In my days as a practicing nurse, I saw many patients whose health improved when they were happier with their living conditions.  When a critically-ill patient can remain in familiar surroundings, the benefits are many: the person retains greater control over their daily lives, families and caregiver report greater satisfaction with the care, and unnecessary hospitalizations are avoided.”

::AWP::