[Congressional Record Volume 161, Number 110 (Wednesday, July 15, 2015)]
[House]
[Pages H5217-H5219]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




     MEDICARE INDEPENDENCE AT HOME MEDICAL PRACTICE DEMONSTRATION 
                        IMPROVEMENT ACT OF 2015

  Mr. RYAN of Wisconsin. Mr. Speaker, I move to suspend the rules and 
pass the bill (S. 971) to amend title XVIII of the Social Security Act 
to provide for an increase in the limit on the length of an agreement 
under the Medicare independence at home medical practice demonstration 
program.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                                 S. 971

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Medicare Independence at 
     Home Medical Practice Demonstration Improvement Act of 
     2015''.

     SEC. 2. INCREASE IN THE LIMIT ON THE LENGTH OF AN AGREEMENT 
                   UNDER THE MEDICARE INDEPENDENCE AT HOME MEDICAL 
                   PRACTICE DEMONSTRATION PROGRAM.

       Section 1866E(e)(1) of the Social Security Act (42 U.S.C. 
     1395cc-5(e)(1)) is amended by striking ``3-year'' and 
     inserting ``5-year''.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
Wisconsin (Mr. Ryan) and the gentleman from Washington (Mr. McDermott) 
each will control 20 minutes.
  The Chair recognizes the gentleman from Wisconsin.


                             General Leave

  Mr. RYAN of Wisconsin. Mr. Speaker, I ask unanimous consent that all 
Members may have 5 legislative days within which to revise and extend 
their remarks and include extraneous materials on S. 971, currently 
under consideration.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Wisconsin?
  There was no objection.
  Mr. RYAN of Wisconsin. Mr. Speaker, I yield such time as he may 
consume to the gentleman from Illinois (Mr. Roskam), the author of this 
bill and a member of the Ways and Means Committee, for the purpose of 
describing this bill.
  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.

                              {time}  1700

  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.
  Mr. McDERMOTT. Mr. Speaker, I yield myself such time as I may 
consume.
  Mr. Speaker, I rise today in support of S. 971, the Medicare 
Independence at Home Extension Medical Practice Demonstration 
Improvement Act of 2015. This bill provides for a 2-year extension of 
an interesting program intended to help beneficiaries living with 
multiple chronic conditions.
  The Affordable Care Act, which has been reviled extensively, 
established the Medicare independence at home demonstration. The 
purpose of this project is to test a new service delivery and payment 
incentive model that utilizes primary care teams directed by doctors 
and nurse practitioners to provide care to patients in their home.
  Practices that successfully reduce costs and meet quality measures 
will be rewarded with incentive payments. If this is successful, this 
model would provide Medicare beneficiaries with access to home-based 
primary care and

[[Page H5218]]

avoid costly and unnecessary trips to the hospital.
  In 2012, 15 practices launched IAH practices, but the authority to 
continue these practices will expire in 2015. S. 971 extends this 
authority by 2 years. This will provide CMS with additional time to 
evaluate the results of the demonstration and to determine whether this 
is a sustainable model to pursue moving forward.
  This will give policymakers the additional information we need to 
inform our decisionmaking as we look for innovative ways to coordinate 
care and reduce costs in the healthcare system.
  It is noteworthy to note that this was instituted by the ACA. There 
are good things in that bill. As they have tried again and again out 
here to repeal it, we never thought about things like independent 
health practices.
  I think that it is important for us, as a Congress, to look 
individually at the programs before we make sweeping generalizations.
  Mr. Speaker, I reserve the balance of my time.
  Mr. RYAN of Wisconsin. I yield 5 minutes to the gentleman from Texas 
(Mr. Burgess), the author of this legislation, a Member of the Energy 
and Commerce Committee, and a physician.
  Mr. BURGESS. I thank the gentleman for yielding. I certainly thank 
him for having this bill on the floor this afternoon.
  I am pleased the House is considering this bipartisan, bicameral 
legislation. S. 971 is identical to H.R. 2196, the Medicare 
Independence At Home Medical Practice Demonstration Improvement Act, 
which I introduced with Mr. Roskam of Illinois and Mr. Thompson of 
California. The bill extends the Medicare independence at home medical 
practice demonstration program for an additional 2 years.
  S. 971 passed the other Chamber with unanimous consent in April. Let 
me reiterate that this bill has cleared the Senate, and we have the 
opportunity to actually advance this bill today and have it become law 
shortly.
  Now, more than ever, it is essential that we consider innovative ways 
to deliver care that is led by providers. Individuals are aging into 
Medicare at a rate of 10,000 seniors a day, with many of the most 
elderly being severely disabled or home limited. It just so happens 
that one of the best ways to both lower costs and improve care is to 
return to the simple house calls of the past.
  The independence at home program puts patients and their families 
first by allowing them to stay at home as long as possible and 
incentivizing their providers to coordinate the care they provide to 
their patients.
  This program targets Medicare beneficiaries with multiple chronic 
conditions who have the highest healthcare costs, require more services 
from providers, and have a greater need for coordinated care.
  Independence at home allows providers to take a more active role in 
patient care and is proving to decrease unnecessary hospitalizations, 
unnecessary ER visits, and unnecessary nursing home visits.
  Independence at home offers incentives to doctors, specialists, and 
nurse practitioners to better coordinate care for patients while also 
cutting costs. This is accomplished by requiring that these groups 
attain a savings of at least 5 percent of which each qualified patient 
would otherwise have cost the Medicare system.
  I will say it again: The program has and must deliver savings by law. 
If these providers fail to achieve the mandatory 5 percent savings, 
they face removal from the program; however, if they are able to 
accomplish the 5 percent savings threshold, these groups may keep up to 
80 percent of the savings.
  This program is proving to reduce costs and increase quality by 
reducing duplicative and unnecessary services, delaying or eliminating 
the need for nursing home placement, and reducing readmissions to the 
hospital simply by having a coordinating team of providers.
  In addition to saving Medicare money, the patient and their family 
are able to spend quality time at home, instead of the doctor's office 
or a hospital. In fact, these programs must improve patient and 
caregiver satisfaction for the program to continue.
  This demonstration program is generating substantial savings and 
positive outcomes. While the Congressional Budget Office estimated a 
zero score on June 12, a week later, the Centers for Medicare and 
Medicaid Services released practice results from year one of the 
program, showing a savings of $25 million the first performance year.
  Since CMS has been able to release the data, we are confident that if 
the Congressional Budget Office were to look at this bill again, they 
would estimate savings for the program, and we expect higher savings in 
coming years.
  Without this extension, there would be a disruption in care for 
Medicare beneficiaries and lost savings that are being generated for 
the Medicare Program.
  A vote in favor of S. 971 is a vote in favor of ensuring improved, 
better managed care for chronically ill Medicare beneficiaries and 
smarter spending in the Medicare Program.
  This bill has gone through regular order. It passed the Ways and 
Means Committee. I would like to thank Chairman Ryan and Ranking Member 
Levin for that. I would also like to thank the Ways and Means Committee 
staff on both sides of the dais, as well as the Energy and Commerce 
staffs, for discharging and advancing the bill.

  I want to thank Representative Roskam and Representative Thompson and 
their staffs. I certainly want to thank J.P. Paluskiewicz and Lauren 
Fleming from my office who have worked to get this bill to the floor.
  Mr. Speaker, the program has been a success. Mr. Speaker, the program 
has no cost. Mr. Speaker, the program is generating savings. If it does 
not generate savings in the future, it goes away.
  This program is generating higher satisfaction for Medicare 
beneficiaries. If it does not generate beneficiary satisfaction in the 
future, it goes away.
  The Senate has already passed this bill by unanimous consent. Mr. 
Speaker, there is no reason for us not to do so as well.
  I urge everyone to vote in the affirmative.
  Mr. McDERMOTT. Mr. Speaker, I yield 4 minutes to the gentleman from 
California (Mr. Thompson).
  Mr. THOMPSON of California. I thank the gentleman for yielding.
  Mr. Speaker, I rise in strong support of S. 971, the Medicare 
Independence at Home Extension Medical Practice Demonstration 
Improvement Act. As was pointed out, it is a 2-year extension to a very 
important and critical component of ObamaCare.
  I thank Mr. Roskam from Illinois and Mr. Burgess from Texas, the two 
folks who coauthored the House bill with me. I appreciate them and 
their staff for the great work they did.
  According to the Centers for Medicare and Medicaid, more than two-
thirds of Medicare beneficiaries suffer from multiple chronic 
conditions, the care and the treatment for which account for more than 
a majority of the Medicare spending. These costs are expected to 
increase substantially with the growing population of seniors, 
particularly those living with multiple chronic conditions.
  Consequently, there is a need for programs aimed at reducing 
unnecessary hospital admissions and ER visits, strengthening chronic 
care coordination for our sickest seniors, and slowing the growth in 
Medicare spending.
  This program, the independence at home demonstration program, was 
created in ObamaCare to do just that. This program provides chronically 
ill Medicare beneficiaries with primary care services in the comfort of 
their homes, where they will be able to retain their independence, 
dignity, and quality of life. It is essential. In essence, it is 
doctors making house calls, a ``back to the future'' way of providing 
care.
  The demonstration is targeted; it is immediate; it is proven; it is 
fiscally responsible, and it is in high demand by Medicare 
beneficiaries and their families in my home State of California and 
every State in the Nation.
  During its first year, the demonstration saved over $25 million, an 
average of over $3,000 per benefactor. These are very real savings, and 
there is more to come if we act today to extend this important and 
successful demonstration for 2 more years. Without this extension, 
there would be a disruption in care for our most fragile seniors and 
lost savings to the Medicare Program.

[[Page H5219]]

  The independence at home demonstration enjoys strong, bipartisan 
support in both the House and the Senate. It passed the Senate by 
unanimous consent and in the Ways and Means Committee on a voice vote. 
I hope that we do the same here. I urge everyone to vote for this 
important piece of legislation.
  Mr. RYAN of Wisconsin. Mr. Speaker, I have no further speakers, and I 
am prepared to close.
  Mr. McDERMOTT. Mr. Speaker, I have no further speakers. I urge 
Members to vote for the bill, and I yield back the balance of my time.
  Mr. RYAN of Wisconsin. Mr. Speaker, I act on the sentiment of the 
gentleman from Washington.
  I urge Members to vote for the bill, and I yield back the balance of 
my time.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentleman from Wisconsin (Mr. Ryan) that the House suspend the rules 
and pass the bill, S. 971.
  The question was taken; and (two-thirds being in the affirmative) the 
rules were suspended and the bill was passed.
  A motion to reconsider was laid on the table.

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