Providers, professional orgs call for lengthy Acute Hospital Care at Home extension

Add Acute Hospital Care at Home to the list of pandemic-era programs that healthcare stakeholders hope to keep in place.

In March, advocacy group Moving Healthcare Home sent a letter to Congress calling for a five-year extension for the Acute Hospital Care at Home waiver program that is due to expire at the end of 2024. Neatly 70 health systems, technology vendors, and professional organizations signed the letter, which called the waiver “the keystone to the future of home-based care delivery for Medicare patients and beyond.”

The Centers for Medicare & Medicaid Services introduced Acute Hospital Care at Home in November 2020. It was an expansion of Hospitals Without Walls, a program launched in March 2020 allowing health systems to provide hospital services in external facilities to meet the demands of COVID-19 treatment.

Research predating the pandemic indicated patients and caregivers prefer hospital at home over an inpatient stay (provided their vital signs are stable enough to allow for recovery at home). Along with improved patient satisfaction, hospital at home programs are linked to lower readmission and mortality rates, along with lower care costs.

Acute Hospital Care at Home began with six health systems with previously established programs. One provider, Mass General Brigham, published research in January noting fewer than 1 in 6 patients in its post-pandemic program were readmitted within 30 days of their initial discharge. Critically, program director Dr. David Michael Levine said in a statement, outcomes were consistent across diverse populations. Additional research reaffirmed the program’s lower mortality rates and complications compared to in-hospital care, due in part to the reduced risk of falls or hospital-acquired infections.

From the initial six programs, Acute Hospital Care at Home has expanded to more than 320 hospitals. Moving Healthcare Home’s letter suggested 1 in 6 hospitals could have programs in place by 2030.

Several factors explain why Acute Hospital Care at Home has worked for health systems. The technology is familiar, as it’s largely remote monitoring, virtual visit, and alerting tools that are already in place. (These are coupled with routine in-home appointments with visiting nurses.) In addition, the CMS program’s strict eligibility criteria – patients must be in stable condition and have a caregiver present in the home – helps alleviate the institutional burden of selecting patients to participate.

Beyond the clinical benefits, hospital at home programs are poised to save money. Johns Hopkins reported cost savings of up to 30% compared to traditional inpatient care, and actuary Milliman projected potential savings of up to 50%. In part, according to the American Hospital Association (AHA), this is why providers such as Mass General Brigham and Atrium Health hope to free up 10% of inpatient beds by moving patients to a hospital at home program.

Still, Acute Hospital Care at Home is due to expire at the end of the year, and Congressional action is required to extend it. Without an extension of the waiver, AHA said health systems may be reluctant to expand existing programs. Further, health systems that have yet to start a program may struggle to achieve a return on the necessary investments in technology, staffing, and workflow systems.

Moving Healthcare Home’s letter asked to extend the waiver program for at least five years, “to allow home-based services to be developed equitably” and “to avoid any disruption in access to Medicare beneficiaries.”