What are hospital-at-home programs and why are they important?
The hospital-at-home care model — a high-quality, lower-cost approach for providing acute care beyond the hospital walls — continues to gain traction as a safe and versatile way to treat patients amid the pandemic. It can also help expand care in underserved, rural areas and reduce hospital-associated risks for older Americans.
Studies show hospital-at-home programs can deliver safer, cheaper, and more effective care for mid-acuity patients considered stable enough to be monitored and treated in the home. The approach is most appropriate for conditions with well-defined treatments, such as chronic obstructive pulmonary disease (COPD), congestive heart failure, pneumonia, diabetes, and cellulitis.
Expanding hospital-at-home programs – a CMS initiative
Expansion of hospital-at-home programs has been fueled in part by a Centers for Medicare and Medicaid Services’ (CMS) initiative adopted in 2020 to help ease the strain of the pandemic on overburdened hospitals. Questions about the sustainability of the CMS program and ongoing challenges in obtaining private payer reimbursement, however, could undermine continued growth.
Hospital-at-home programs offer lower cost, improved outcomes
Hospital-at-home has long been an effective component of care in nations with single-payer systems, including England, Canada, Australia, and Israel. Adoption in the U.S. has been more constrained, with programs largely limited to the Medicare Advantage and Medicaid managed care markets due to rigid Medicare requirements and difficulties in obtaining reimbursement.
Studies nonetheless highlight the major cost, outcome, and patient experience benefits hospital-at-home programs can produce. A 2018 analysis of patients with heart failure, COPD, or asthma found that costs per-acute-care-episode for hospital-at-home patients were 53% lower than for admitted patients. Home hospital patients also had significantly fewer readmissions (11% vs. 36%) and fewer low-value services, such as consultations and laboratory orders.
Another meta-analysis concluded that hospital-at-home programs were associated with a 20% reduction in mortality and, on average, a 25% reduction in cost-of-stay. A separate study determined that patients treated at home, along with their family members, were more likely to be satisfied with the physician, comfort and convenience, admission process. and the overall care experience.
COVID-19 spurs a new hospital-at-home care framework
In November 2020, CMS introduced the Acute Hospital Care At Home program to help strapped hospitals cope with the surge in COVID-19 patients while reducing infection exposure for non-COVID cases. The initiative for the first time established a regulatory, clinical, and reimbursement pathway for treating acute Medicare fee-for-service patients outside the hospital.
How does the acute hospital care at home program work?
The program requires that hospitals follow rigorous home care screening and safety protocols around more than 60 in-patient conditions. It also waives the requirement that hospitals participating in Medicare provide 24-hour-a-day, seven-days-a week onsite nursing care, and enables reimbursement at in-patient levels for home hospital services.
Clinicians are required to remain connected to patients via daily, in-person visits, telehealth, and continuous biometric monitoring. Hospitals also must ensure the patient’s home is conducive to effective care, with necessary utilities and internet access.
The program has proved an important safety valve for hospitals bending under the pressure of pandemic’s repeated spikes. Since the initiative was launched, 106 health systems and 241 hospitals in 36 states have been approved for participation.
Humana launches hospital-at-home program
In 2021, Humana Inc. became the first major commercial payer to launch a hospital-at-home program. Through a partnership with DispatchHealth, the carrier announced it would provide members living with multiple chronic conditions an opportunity to be treated safely at home. The program was initially rolled out in Denver and Tacoma, with expansion planned for additional markets in Texas, Arizona, and Nevada.
Acute care at home offers improved care for rural areas
Hospitals with hospital-at-home programs are proving particularly beneficial in the 80% of rural America that is considered medically underserved. Presbyterian Healthcare Services, which operates nine hospitals in New Mexico, launched a hospital-at-home program in 2008. The effort provides home care to patients with chronic disease living within 25 miles of a system hospital. Since its inception, the initiative has served more than 1,400 patients at an average cost that is 42% lower than an equivalent hospital stay.
Readmission rates – 30-day and 90-day – have been reduced by 5.6% and 6.4%, respectively, patient satisfaction scores are at 99%, and there have been no infections or wounds acquired at home and no unexplained deaths, according to the health system.
Safer care for seniors
Besides improving care in rural regions, hospital-at-home can significantly reduce the risk of hospital-associated complications for older Americans. These hazards can include heighted opportunity for infection, adverse drug events, reduced cognitive function, and falls.
Hospital-at-home reimbursement - an uncertain landscape
Despite the benefits associated with hospital-at-home programs, reimbursement remains a major question mark, since most private payers do not yet cover hospital-level care in the home setting, according to the American Hospital Association.
In addition, the CMS hospital-at-home program is slated to expire with the end of the COVID-19 Public Health Emergency. The emergency was scheduled to end in mid-July, although observers believe it may be extended until mid-October.
Legislation introduced in March would sustain the hospital-at-home initiative for two years beyond the expiration of the health emergency and require the Department of Health and Human Services to explore making permanent adjustments in at-home services for Medicare patients. In a press release supporting the bill, Stephen Parodi, M.D., a spokesperson for the Advanced Care at Home Coalition, noted that “the benefits of advanced care at home will serve patients well beyond the pandemic.”
The American Hospital Association agrees: “The COVID-19 pandemic has spurred a number of innovations in health care delivery that have the potential to positively alter how care is provided in the years ahead,” said Julia Resnick, senior program manager for strategic initiatives with AHA. “Hospital-at-home is one of those promising models.”
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