Attention Deficit

Sometimes good ideas go unnoticed.

Recently Rep. Ed Markey and Sen. Ron Wyden introduced legislation to study whether expansion of at-home services for Medicare beneficiaries would help those patients and, at the same time, save money for the program.

Called the Independence at Home Act, the bill creates a three-year demonstration project under which physicians or nurse practitioners in 26 states work with their Medicare patients to devise a comprehensive care plan. Eligible beneficiaries include those with two or more chronic conditions and multiple hospitalizations.

The proposal holds providers accountable for outcomes and requires savings of at least 5 percent compared to the cost of serving non-participating beneficiaries with chronic health problems. Providers would be able to keep 80 percent of any savings beyond 5 percent as an incentive for participation.

The bill is premised on the widely acknowledged facts that Medicare beneficiaries with multiple chronic conditions account for a disproportionate share of spending, and that evidence suggests such patients often receive poorly coordinated care. Its authors say people with chronic conditions account for 76 percent of all hospital admissions, 88 percent of all prescriptions filled and 72 percent of physician visits.

They also point out that unless changes are made to the way health care is delivered, growing demand for resources caused by rising health care costs and the nation's exploding elderly population will confront all of us with increasingly difficult choices between health care and other priorities.

It seems to me there are some tough choices confronting us already. Medicare's Trust Fund will go broke in the next decade unless changes are made. Medicaid has now been busting states' budgets for years. And the State Children's Health Insurance Program (SCHIP) will soon require refunding — again — and who knows where those funds will come from? (Remember the battle over this program in 2007 when Congress wanted to fund it with higher cigarette taxes?)

Markey and Wyden say their legislation would create savings by improving beneficiaries' care and reducing duplicate and unnecessary health care costs. In contrast, they note, Medicare's current fee-for-service payment system creates incentives to provide fragmented, high-cost services.