Hospital At Home: The Future Of Care, But Policy and Payment Must Keep Up
12/1/2023
This article first appeared as a column in the December issue of South Florida Hospital News
By Mary Mayhew, FHA President and CEO
Among other impacts, the pandemic served as a catalyst to skyrocketing adoption and use of telemedicine as well as to reimagining how healthcare can be delivered. The Acute Hospital at Home programs quickly advanced during the pandemic to allow hospitals to safely and successfully support certain hospital patients in the comfort of their own homes.
More than 300 hospitals in 37 states have permission from the Centers for Medicare & Medicaid Services to provide home-based inpatient-level care. This number has grown exponentially since CMS first authorized the Hospital at Home program in November 2020. Fifteen Florida hospitals have Hospital at Home programs.
Many hospitals were at capacity during the worst days of the COVID-19 pandemic, meaning they had no additional staffed beds to care for patients with COVID-19 or other conditions. A temporary Centers for Medicare & Medicaid Services waiver in November 2020 of several Medicare Conditions of Participation made hospital care at home possible, adding capacity to the overloaded system, increasing emergency department throughput, and improving patient outcomes and satisfaction. While this innovative model was beneficial during the pandemic, it continues to be a transformative opportunity for how hospital care can be effectively supported, especially with the availability of new and emerging technologies.
Although patient care is delivered in the patient’s home, Hospital at Home programs require patients to need an inpatient hospitalization level of care. The features of each Hospital at Home program vary from hospital to hospital, but patients receive at least daily physician visits, which can be conducted via telemedicine, and twice daily in-person nurse visits (one of these visits may be by a mobile integrated health care – community medicine provider, i.e., a qualified EMS provider working as part of the hospital’s coordinated care team). Nurses can also deliver meals if needed. In addition, telemedicine visits are established with members of the pharmacy, care coordination, spiritual care teams, or other resources as needed. Studies have shown that Hospital at Home programs can reduce the length of patient stays, reduce readmissions, improve health care outcomes, and deliver higher patient satisfaction. The ability to assess a patient’s home environment for risk of falls, to evaluate their nutrition by reviewing their food supply, and the opportunity to directly engage with the patient and their family caregivers in their homes is incredibly important to improving the treatment plan, reducing readmissions and building greater confidence for the patient and in their caregivers.
Post-pandemic state and federal regulation and payment policies, however, are not keeping up with the growing use and success of the care model. While federal authorization of the programs is in place temporarily through December 2024, it is imperative that Congress make this authorization permanent. Additionally, while Florida regulators have provided significant support to hospitals for the Acute Hospital at Home program, it is critically important that the Florida Medicaid program and the Medicaid Managed Care plans provide reimbursement for this model of care. Hospitals will be prioritizing advocacy during the 2024 legislative session to secure a budget directive for the Agency for Health Care Administration to provide Medicaid reimbursement to the Hospital at Home Program.
Hospital at Home programs are a shining example of hospital innovation. As the saying goes, “Necessity is the mother of invention,” and hospitals responded to the unprecedented need for care during the pandemic with creativity and agility to maintain clinical excellence and patient satisfaction. Today, hospitals need policy support, so the innovative gains of Hospital at Home aren’t lost.