Statements on Introduced Bills and Joint Resolutions

Floor Speech

STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS -- (Senate - September 26, 2008)

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By Mr. WYDEN (for himself, Ms. Mikulski, Mr. Whitehouse, and Mr. Cardin):

S. 3613. A bill to amend title XVIII of the Social Security Act to provide certain high cost Medicare beneficiaries suffering from multiple chronic conditions with access to Independence at home services in lower cost treatment settings, such as their residences, under a plan of care developed by an Independence at Home physician or Independence at Home nurse practitioner; to the Committee on Finance.

Mr. WYDEN. Mr. President, together with colleagues in the Senate and the House, I am introducing the Independence at Home, IAH, Act. This legislation will help Medicare and our Nation improve the efficiency and effectiveness of spending on Medicare beneficiaries with multiple chronic conditions. It will not only improve care for seniors suffering from serious illnesses but also save money.

Roughly 75 percent of the Nation's health care dollars are spent on chronic diseases. Yet spite this enormous investment, today's chronically ill only receive just over half, 56 percent, of the preventive and maintenance services that they need. Our Nation clearly needs to do better.

Recent Medicare demonstrations have shown that a number of key improvements could go a long way to help fix this situation: First, primary care physicians and key health professionals must assume more responsibility for care coordination; second, we need to target efforts at beneficiaries with multiple conditions; third, after-hours care needs to be available so people can access medical help when they need it and avoid calling 911; and finally, there must be better use of health information technology to help manage care.

The optimal way to address the challenges of caring for persons with chronic conditions is to better integrate their care. Medical problems are best managed and coordinated by health care professionals who know their patients, their problems, their medications, and their other health care providers. Using this approach, the IAH provides a better, more cost-effective way for Medicare patients with chronic conditions to get the care they need.

We do all these things in the legislation I am introducing along with colleagues in the Senate and House: Our bill would put in place a demonstration that improves at-home care availability for beneficiaries with multiple chronic conditions to help people remain independent in their homes. Physicians would get paid better for managing care while at the same time they would be responsible for demonstrating at least 5 percent savings in the cost of their patients' care. The bill also includes minimum performance standards for patient health outcomes, and would measure patient, caregiver and provider satisfaction.

The Independence at Home Act establishes a three-year Medicare demonstration project that uses a patient-centered health care delivery model to ensure that Medicare beneficiaries with multiple chronic conditions can remain independent for as long as possible in a comfortable environment; advances Medicare reform by creating incentives for providers to develop better and lower cost health care for the highest cost beneficiaries; incorporates lessons from past Medicare demonstration projects; provides for physician and nurse practitioner-directed programs that hold providers accountable for quality, patient satisfaction, and mandatory annual minimum savings; and generates savings by providing better care to Medicare beneficiaries with multiple chronic conditions and reducing duplicative and unnecessary services, hospitalization, and other health care costs.

The demonstration program will take place in the thirteen highest-cost states plus thirteen additional states. Persons eligible for the program include Medicare beneficiaries with functional impairments, two or more chronic health problems, and recent use of other health services. Each IAH patient will receive a comprehensive assessment at least annually. The assessment will inform a plan for care that is directed by an IAH physician or nurse-practitioner and developed in collaboration with the patient. Each patient will also have an IAH plan coordinator. Electronic medical records and health information technology will be employed to improve patient care. The IAH organization will be required to demonstrate savings of at least 5 percent annually compared with the costs of serving non-participating Medicare chronically ill beneficiaries. The IAH organization may keep 80 percent of savings beyond the required 5 percent savings as an incentive to maximize the financial benefits of being an IAH member.

I would like to thank my cosponsors in the House, Representatives Ed Markey, Chris Smith and Rahm Emanuel for their support, along with my fellow Senate cosponsors, Senators Barbara Mikulski, Benjamin Cardin and Sheldon Whitehouse. I would also like to thank all our staff who worked so hard on this legislation, particularly Gregory Hinrichsen in my office. Finally, we would like to thank the following groups for voicing their support for this legislation: the American Academy of Home Care Physicians; the AARP; the American Academy of Nurse Practitioners; the National Family Caregivers Association; the Family Caregiver Alliance/National Center on Caregiving; the American Association of Homes and Services for the Aging; the Maryland-National Capital Home Care Association; the Visiting Nurse Associations of America, and Intel Corp.

I urge all of my colleagues to support this important legislation to help Medicare patients get better care at lower cost.

Mr. President, I ask unanimous consent that the text of the bill be printed in the RECORD.

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