Independence At Home Act: Critical in Health Care Reform

With all the political thought-jogging regarding Health Care Reform, one of the most important elements currently being studied is the Independence At Home Act. If this is enacted as part of Health Care Reform, it could potentially help to reduce costs associated with Medicare and would provide an avenue for better health maintenance for others who may be chronically ill but wish to remain at home rather than in a hospital. House calls, as they were once known, became popular in the 1930's and remained so for many years. It was rather standard practice that your family doctor would come to your home, assess your medical problems and provide treatment. That diminished in the 1950's and by 1980 house calls by physicians dwindled to less than one percent. There were a number of reasons for this, but it was primarily the lack of reimbursements by insurance companies to doctors for house calls that became a disincentive for that care. That outlook has begun to change.

Congressman Edward Markey of Massachusetts has authored The Independence At Home Bill. Markey stated, "Our current health care system does a poor job caring for seriously ill Americans who are often lost in transition. This bipartisan, bicameral bill holds great promise for improving quality of care, reducing hospitalizations, lowering costs 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."

On October 13, 2009 the Senate Finance Committee approved Chairman Max Baucus' healthcare reform legislation, the America's Healthy Future Act of 2009. The bill has advanced with an amendment written by Sen. Ron Wyden, a co-sponsor of the Independence at Home Act of 2009. Wyden's amendment would create a pilot program of teams of healthcare professionals to care for patients with chronic conditions in their homes. This could help to eliminate unnecessary services and would provide care in a consistent and coordinated manner.

Per Wyden's statement, "patients with multiple chronic conditions comprise less than one quarter of Medicare beneficiaries, but account for 66 to 84 percent of Medicare spending, 76 percent of all hospital admissions, 88 percent of all prescriptions filled and 72 percent of physician visits. The Independence at Home Amendment would generate cost savings by reducing the number of emergency room visits and unnecessary hospitalizations."

The American Academy of Home Care Physicians estimated that one million senior citizens are homebound, and another two to three million find it difficult to travel, due to transportation and health issues. The Department of Veterans Affairs launched its own house-call program in the 1970's due to an expanding population of older veterans suffering from multiple chronic conditions. An analysis of one such program in Missouri showed costs going from $45,000 per patient to $17,000, said Dr. Thomas Edes who ran that program.

It is not only a moral imperative that Independence At Home be enacted; it is a fiscally sound resolution to rising costs of health care. Given that physicians can provide some services such as EKG's, blood work, urinalysis, X-rays and ultrasound studies with portable equipment, it is unnecessary that so many Americans, particularly those who are chronically ill, are forced to transport themselves to an emergency room for those services. We would be well-served as a nation to have the Independence At Home Act as part of any health care reform legislation.