Throughout the COVID-19 pandemic, the Centers for Medicare and Medicaid Services (CMS) issued a number of waivers and flexibilities to help healthcare providers manage the influx of patients during the Public Health Emergency (PHE). The implementation of the Acute Hospital Care at Home (AHCaH) individual waiver in 2020 allowed qualifying hospitals to provide hospital at home (H@H) programs. These programs provide similar services as those administered during inpatient visits, such as physician visits and monitoring, drug prescription, nursing services, diagnostics, etc. Since its employment, 144 systems including 260 hospitals across 37 states have utilized the AHCaH waiver, rapidly increasing the number of H@H programs in the United States. While the initiative was originally set to expire with the end of the PHE, the AHCaH waiver program was extended until December 31, 2024, with the passing of the Consolidated Appropriations Act, 2023 (CAA 2023). The extension of this program sends a strong message about the importance of permanently integrating home-based care delivery models into our healthcare system. Despite the lengthy extension, the nature of this waiver program remains temporary and the concerns about the expiration effects on relevant stakeholders continue to be pertinent.
Patients of H@H programs have been found to benefit from this method of health care delivery in a myriad of ways. H@H programs can increase the accessibility and availability of health care services for patients. At home visits by medical personnel also allow for the patient’s social determinants of health to be assessed, which can lead to more well-rounded care. With less time spent within a hospital setting, patients utilizing these programs have less of a chance of developing hospital-acquired infections. According to a meta-analysis conducted on H@H programs, there are lower rates of readmission and reductions in mortality with this care delivery model. The expiration of the AHCaH waiver program would decrease the number of H@H programs available, making it more difficult for Medicare patients to receive quality care from the comfort of their home.
H@H programs have enabled providers to maximize inpatient bed capacity for patients with more critical health needs, an issue that became more pressing during the COVID-19 pandemic. Studies have found that there is greater healthcare professional satisfaction with H@H delivery models. Without the AHCaH waiver in place, hospitals will have to shift back heavily to inpatient acute hospital care. This is of particular concern should under-staffed and under-resourced hospital systems face infectious outbreaks, epidemics or pandemics in the future. Many of the hospitals that have utilized the AHCaH waiver and created H@H programs noted having to turn patients away due to capacity issues before the COVID-19 pandemic, suggesting capacity issues will continue to be an issue for hospitals without H@H programs.
Patient services through the H@H care delivery model have generally been found to be less expensive than traditional hospitalizations. One study found that the payer saves more than 50% with at home care compared to an acute inpatient stay, when considering all facility, professional, and ancillary services with the Medicare home care reimbursement plan. Programs like H@H invite innovative ideas regarding payment models and value-based care, which could lower costs and provide higher-quality health care.
In accordance with the CAA 2023, the Secretary of HHS will conduct a study comparing the quality and quantity of services as well as the clinical conditions of patients served in inpatient settings and in H@H programs over the two-year extension period. This study is expected to gather information on the costs of H@H treatment relative to in-patient care and socioeconomic information on the beneficiaries treated under the initiative. Hospital and home-care coalitions are calling on CMS to develop a demonstration project for a new reimbursement model for H@H programs serving Medicare beneficiaries as a next step to transition the temporary AHCaH waiver into a permanent part of the health care delivery system. Despite the recent two-year extension, there is still a need to discuss how these COVID-19 era waiver flexibilities, including H@H programs, telehealth services, and home health agencies, will develop into permanent fixtures of the health care system. Please contact any of the authors of this post or any other Crowell Health Solutions staff to discuss the H@H program or any related services.