[Congressional Record Volume 155, Number 79 (Thursday, May 21, 2009)]
[Extensions of Remarks]
[Page E1236]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




              INTRODUCTION OF THE INDEPENDENCE AT HOME ACT

                                 ______
                                 

                         HON. EDWARD J. MARKEY

                            of massachusetts

                    in the house of representatives

                         Thursday, May 21, 2009

  Mr. MARKEY of Massachusetts. Madam Speaker, I rise today to introduce 
the Independence at Home Act. I would like to thank my colleague and 
fellow co-chair of the bipartisan Alzheimer's Task Force, Mr. Chris 
Smith of New Jersey, for working with me on this important legislation.
  As health care reform efforts move forward, we have a golden 
opportunity to provide high-quality care for our most vulnerable 
seniors right in their own homes at dramatically lower costs. The bi-
partisan Independence at Home legislation we are reintroducing today 
aims to better coordinate care for Medicare beneficiaries with 
multiple, debilitating chronic diseases, including Alzheimer's, 
congestive heart failure, diabetes and other chronic conditions.
  In many cases, our frail elders prefer to remain in their own homes, 
in the comfort of familiar surroundings, rather than enter a nursing 
home or hospital. Our current health care system does a poor job caring 
for seriously ill Americans, who often are ``lost in transition'', 
struggling to manage multiple illnesses as they transition between 
emergency room, hospital, nursing facility and home. The Independence 
at Home Act holds great promise for reducing hospitalizations, 
preventing medication errors, and lifting the spirits of those who, 
after a lifetime of contributions to our society, deserve the dignity 
and peace of mind that comes with living independently.
  This legislation builds on successful house calls programs operating 
around the country and at the Department of Veterans Affairs by 
establishing a 3-year pilot program in Medicare that would enable 
beneficiaries with chronic, complex conditions to receive the care they 
need in their own homes. These patients see roughly 14 physicians and 
fill about 50 prescriptions each year. Due to a lack of coordination 
between their many doctors, these patients often receive disjointed 
care, conflicting information, and multiple diagnoses for the same 
symptoms. At the same time, Medicare beneficiaries with multiple 
chronic conditions account for a highly disproportionate share of 
Medicare spending.
  The Independence at Home Act creates a three year pilot program that 
utilizes a patient-centered health delivery model to ensure that 
Medicare beneficiaries with multiple chronic conditions can remain 
independent, in their homes, for as long as possible. Our model is a 
better, more coordinated way of getting these patients the care they 
need by physicians who know them and are experienced in managing their 
unique needs.
  The Independence at Home care teams tasked with coordinating the care 
of these patients will be comprised of qualified and experienced 
physicians, physician assistants, and nurse practitioners. 
Participating organizations will be required to produce improved health 
outcomes, demonstrate patient and caregiver satisfaction, and show that 
their methods result in savings to Medicare. In order to realize these 
savings, our bill holds participating providers accountable for 
demonstrating a minimum savings of 5 percent to Medicare. As an 
incentive, providers are able to keep a portion of savings they achieve 
beyond the initial 5 percent. Whereas our current health care system 
runs up costs by reimbursing for the volume of care, the Independence 
at Home model incentivizes the value of care.
  This proposal also encourages the adoption of electronic medical 
records and other technologies that will result in more efficient and 
cost-effective care. And, to help address the existing shortage of 
primary care physicians, this bill develops a new, promising career 
path for primary care physicians who can own and operate Independence 
at Home organizations and receive reimbursements for house calls.
  The Independence at Home Act addresses the needs of patients with 
multiple chronic diseases and holds providers accountable for producing 
savings. As such, I believe this bill to be a critical part of our 
efforts to reform health care because it will produce better, 
coordinated care and reduce costs. I look forward to working with my 
colleagues in the House to turn our ``sick-care'' system into a true 
health care system, and I look forward to working on this bill with my 
colleagues as efforts proceed to pass comprehensive health care reform 
this year.

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