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Affordable Care Act Payment Program Boosts Care, Cuts Costs

The Independence at Home Demonstration, a payment model under the Affordable Care Act, has shown improved quality of care and reduced spending among participating physician practices.

By Vera Gruessner

The Patient Protection and Affordable Care Act has a wide variety of reforms that have been implemented to improve care for American citizens. One of these reforms includes a payment model called the Independence at Home Demonstration operated through the Centers for Medicare & Medicaid Services (CMS). Yesterday, CMS announced in a news release that the Independence at Home Demonstration is continually providing high quality care while cutting costs for the Medicare program.

Medicare Payment Model

An analysis from CMS shows that the Independence at Home Demonstration saved CMS more than $10 million during its second performance year. The program has brought higher quality care in the patients’ own homes and saved each beneficiary an average of  $1,010, reports CMS.

“The Independence at Home Demonstration is a patient-centered model that supports providers in caring for chronically ill patients in their own homes,” Dr. Patrick Conway, CMS Acting Deputy Administrator and Chief Medical Officer, said in a public statement. “These results continue to support what most patients already want – the ability to have high quality care in the home setting.”

Physician practices that participate in the Independence at Home Demonstration have the opportunity to receive incentive payments. CMS states that it will award seven practices a combined amount of $5.7 million due to the fact that these participants reduced spending for the Medicare program and improved care for their patient base.

More than 10,000 Medicare beneficiaries and 15 practices took part in this program during its second year of operation. The CMS analysis found that, out of the six quality measures analyzed, all 15 practices improved quality upon at least two out of the six since the first operating year. Four participating practices improved quality in each of the six quality measures.

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During the first year of operation, the results were also promising, as stated by CMS Acting Administrator Andy Slavitt in a press release from June 2015.

"These results support what most Americans already want-- that chronically ill patients can be better taken care of in their own homes. This is a great common sense way for Medicare beneficiaries to get better quality care with smarter spending from Medicare," Slavitt said in the release. "The Independence at Home Demonstration is one of the tools of the Affordable Care Act that can bring down the long-term cost of care in a patient-centered manner."

The practices that exceeded their spending targets include Cleveland Clinic Home Care Services, Doctors Making Housecalls, Doctors on Call, Housecall Providers, Housecall Providers, Inc., Mid-Atlantic Consortium, Northwell Health Care, VPA Dallas, VPA Flint, VPA Lansing, and VPA Milwaukee.

The way the Independence at Home Demonstration works is by allowing providers to conduct at-home assessments of a patient’s health and hold the providers to greater accountability.

The way this program saves costs is by ensuring that these patients are less likely to need healthcare in an actual medical facility and are cared for by medical professionals within the home before a condition worsens. This program was set up under the Affordable Care Act to operate for three years but was extended by an additional two years through September 30, 2017.

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“This focus on timely and appropriate care is designed to improve overall quality of care and quality of life for patients served, while lowering healthcare costs by forestalling the need for care in institutional settings,” CMS stated on its website.

“The Independence at Home Demonstration will build on these existing benefits by providing chronically ill patients with a complete range of primary care services in the home setting. Medical practices led by physicians or nurse practitioners will provide primary care home visits tailored to the needs of beneficiaries with multiple chronic conditions and functional limitations.”

Some of the results from the Affordable Care Act payment model includes doctors following up with patients within 48 hours after they’ve been discharged from the hospital or emergency room, a reduction in 30-day hospital readmission rates, documentation about patient preferences, and inpatient hospital stays and emergency room visits were reduced for chronic illnesses such as asthma, diabetes, and high blood pressure.

Additionally, patients are more likely to have any questions about their medications answered and reconciled within 48 hours after a hospital discharge or emergency room visit.

The Affordable Care Act and various healthcare reforms adopted by CMS have positioned the healthcare industry to adopt alternative payment models such as bundled payments and other value-based care reimbursement strategies.

READ MORE: CMS Awards $22M for Cost Transparency Under Affordable Care Act

This past March, CMS reached its goals of tying 30 percent of Medicare payments to alternative payment models, which was almost a year ahead of its initial schedule.  Alternative payment models focus on paying for the quality and value of care instead of the quantity of services.

This Affordable Care Act payment model is showing some significant benefits for both saving costs and improving care for Medicare beneficiaries. These new type of healthcare reforms are likely to make enough of an impact for the healthcare industry to continue investing in physicians making home visits to better patient outcomes. Despite some of the opposition to the Affordable Care Act, various ACA provisions have clearly benefited patient health outcomes and reduced spending.

Image Credits: Centers for Medicare & Medicaid Services


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