CMS home care demo sees reduced savings in second year

A CMS analysis said its Independence at Home Demonstration program saved over $10 million in its second performance year, a decline from the $25 million in savings from its first year.

The reduction in savings came despite the program serving more beneficiaries in its second year, with more than 10,000 among 15 participating practices compared to more 8,400 in 17 practices in the first year. The agency focused on the positive results in its press release, saying the program continued to improve care and lower costs for chronically ill beneficiaries being treated at home.

“The Independence at Home Demonstration is a patient-centered model that supports providers in caring for chronically ill patients in their own homes,” said Patrick Conway, MD, CMS acting deputy administrator and chief medical officer. “These results continue to support what most patients already want – the ability to have high quality care in the home setting”.

The performance of practices appeared to have declined slightly based on the following quality measures:

• Follow up contact within 48 hours of a hospital admissions, hospital discharge, and emergency department visit.
• Medication reconciliation in the home within 48 hours of a hospital discharge and emergency department visit.
• Annual documentation of patient preferences.
• All-cause hospital readmissions within 30 days.
• Hospital admissions for Ambulatory Care Sensitive Conditions.
• Emergency department visits for Ambulatory Care Sensitive Conditions.

In the first year, all 17 participants improved quality in at least three of the six categories. For year two, the 15 participants improved in just two of the six. In both years, four practices met performance standards in all six categories.

The decline in performance may have led to CMS awarding less in incentive payments to practices that “succeeded in reducing spending while improving quality.” Seven practices received a total for $5.7 million in incentives in the second year, down from $11.7 million for nine practices in the first year.

The savings the model has achieved haven’t gone unnoticed by policymakers. In July, U.S. Sen. Edward Markey, D-Massachusetts, introduced the Independence at Home Act, which would convert the demonstration into a nationwide program.