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Is There a Future for the Hospital at Home Strategy?

Analysis  |  By Eric Wicklund  
   August 01, 2024

The Bipartisan Policy Center is recommending that Congress extend the CMS model for five years and study whether the innovative program is cutting costs and improving care outcomes.

The Bipartisan Policy Center is recommending that the Centers for Medicare & Medicaid Services extend the Acute Hospital Care at Home (AHCaH) program for another five years while launching a study to determine whether the innovative program is reducing costs and improving care outcomes.

The Washington-based think tank’s report comes at a crucial time for supporters of the Hospital at Home strategy. The November 2020 waiver issued by CMS for its AHCaH model, which relaxes rules on providing home-based acute care and enables hospitals and health systems to seek Medicare reimbursement, is set to expire at the end of this year, a move that could threaten the sustainability of many programs.

Currently CMS has authorized 331 health systems and hospitals to operate an ACHaH program, though not all are doing so; others are running or developing variations of the acute care at home model.

[Also read: Survey Shows Public Support for Hospital at Home Programs.]

“Research shows that hospital at home models yield positive health outcomes,” the BPC report states, citing a small study which found that the program led to shorter hospital stays, lower readmission rates, fewer diagnostic tests, and lower costs compared to patients admitted to the hospital for the same health concerns.

“Initial data show promise, including the potential for cost savings,” the report added. “But more research is needed on patient and caregiver experiences, access and patient selection, the cost impact on Medicare and Medicaid, hospital expenses, and service delivery across diverse populations. Research is also needed on whether the relatively small number of hospitals participating is nonrepresentative and unique. … Congress needs more clarity about the likely financial effects of the model if it were to move from a model with low uptake, which is the case today, to something that would be implemented on a larger scale.”

An Alternate Take on the Hospital at Home Model

While the model has drawn a lot of support, including a users group of healthcare organizations lobbying to make the model permanent, it has its detractors. Some have said the program is too complex and costly, drawing on too many resources for patients who should be hospitalized.

[Also read: Patient Experience is Crucial to the Success of Hospital at Home.]

Among the critics is Sachin Jain, MD, MBA, president and CEO of the Los Angeles-based SCAN Group and Health Plan, who argues the complex program “promotes caregiver burnout, costs too much, and can be of variable quality.”

Jain argues that the model should be re-evaluated to filter out what he calls the “toxic positivity that has defined the hospital-at-home movement.” In certain cases the program will work, he adds, but there has to be “a definable cost advantage and sound, scalable, highly reliable underlying logistics.”

Immediate and Long-Term Recommendations

The BPC report offers several immediate policy recommendations, including:

  • Congress should extend the AHCaH model for five years to maintain participation, support investment from payers and providers and gather additional evidence on the program’s value. “A temporary reauthorization of five years would likely increase participation in AHCaH and incentivize state Medicaid investment, improving the diversity of participation,” the report said. “It would also allow policymakers to collect data on the model to guide future reauthorizations and make informed programmatic and financial decisions.”
  • Congress should provide funding for and direct CMS to provide technical support for health systems and states launching the ACHaH model, especially to improve access for Medicaid members.
  • Congress should also provide funding for a CMS-initiated study of the cost and quality of the ACHaH model, with a report submitted back to Congress by September 2028.
  • Congress should direct CMS to strengthen regulatory guidance for health systems and hospitals that include evidence-based protocols for the use of telehealth and remote patient monitoring (RPM), infectious prevention practices, fall prevention and escalation for clinical deterioration.
  • Congress should direct CMS to create quality measures for the ACHaH model, covering functions like tracking adverse events beyond mortality, a patient’s ability to connect with the care team after hours, and care team response times to escalations.
  • Congress should direct CMS to develop evidence-based, standardized language for health systems and hospitals to use when offering the program to patients.

The report also identifies key issues that federal policymakers will need to address when deciding the future of the program beyond five years. They include whether to make the program permanent, extend it further or end it; whether to modify the model to ensure sustainability; and how to ensure safety and program integrity as more health systems and hospitals adopt the model.

Eric Wicklund is the associate content manager and senior editor for Innovation at HealthLeaders.


KEY TAKEAWAYS

CMS introduced the Acute Hospital Care at Home program during the pandemic and supported it with a waiver enabling participating hospitals to bypass certain requirements and receive Medicare reimbursement.

That waiver will expire at the end of this year, and supporters are arguing that the program should either be extended or made permanent.

Supporters say the program is improving care outcomes and reducing hospital costs, but some critics say it’s too complicated and costly, leading to caregiver burnout and added expenses.


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