Technology & Reimbursement Accelerating Hospital at Home Trend
The hospital at home (HaH) model continues its ascent, jump-started by the pandemic. While not a new model – it dates back to 1995 – today’s technology, temporary changes to reimbursement, and omnichannel approach to care is accelerating adoption nationally. Just in January 2022, five health systems launched programs, indicating a ramp-up that is expected to continue. And, as of February 2022, 201 hospitals had achieved CMS approval.
CMS Acute Hospital Care at Home & Hospitals Without Walls Program
Over the past two years, moving more care to the home has been necessary due to the pandemic with a shortage of hospital beds and a desire to limit exposure to COVID-19 for older adults. In March 2020, CMS launched the Hospitals Without Walls program that allowed care provisions for locations outside the hospital. Then, in November 2020, they expanded to the Acute Hospital Care at Home program that allowed hospitals to receive Medicare reimbursement for at-home care services provided to patients for more than 60 conditions. Prior to the pandemic, a Medicare fee-for-service reimbursement method for hospital-at-home services did not exist.
While the program is considered an extension to physical hospitals, CMS requires participating healthcare organizations to report monthly on three metrics – unanticipated mortality, transfer to inpatient care at a physical hospital, and volume of patients treated. Providers must implement screening protocols to assess medical and non-medical factors prior to care beginning, including working and accessible utilities, assessment of physical barriers, as well as screenings for domestic violence concerns.
Beneficiaries can only be admitted through emergency departments or as an inpatient. An in-person physician pre-evaluation is required and a registered nurse should evaluate each patient daily in person or remotely along with daily in-person visits by RNs or integrated health paramedics.
“…given the choice between having inpatient-level care at home or in the hospital, 61% would choose to be at home.”Healthcare Finance News
Hospital-level Care for Acutely Ill Older Adults at Home
As of 2022, there are over 200 health systems and hospitals participating in the program. Once referred into the program and assessed, patients are mainly diagnosed with conditions like asthma, congestive heart failure (CHF), pneumonia, and chronic obstructive pulmonary disease (COPD).
This level of hospital-acuity care may require various diagnostic measures or treatments, including electrocardiograms, echocardiograms, X-rays, oxygen therapy, and intravenous fluids or antibiotics. Virtual care and telehealth technologies, remote patient monitoring, and digital therapeutics are key technologies that enable the program.
“Rarely in the history of medicine do we see such a perfect alignment of policy, technology and cultural transformation converging to produce a new care paradigm like acute care at home.”Dr. John Halamka, president of Mayo Clinic Platform
Hospital at Home Offers Promising Outcomes
Johns Hopkins’ first national study of their hospital at home model was published in 2005, finding improved outcomes:
- Better clinical outcomes
- A shorter average length of stay (3.2 days versus 4.9 days)
- Higher patient and family satisfaction
- Fewer lab and diagnostic tests compared to similar hospitalized patients
- Fewer complications often associated with hospital stays, such as delirium, infections and the need for sedative medications or physical restraints
- Lower care costs by up to 30 percent compared to traditional inpatient care
Other organizations have documented their outcomes to similar programs:
- Presbyterian Healthcare Services published in 2012 that Medicare Advantage and Medicaid patients treated through the program had 19 percent lower costs and similar or better outcomes when compared to hospitalized patients.
- Mount Sinai’s program published a case study in 2014, reporting 30-day readmission rates for HaH patients of 8.6 percent compared to 16.1 percent for hospitalized patients.
- UnityPoint Health lowered their 30-day ED readmission rate from 27 percent to 4 percent for HaH patients, achieving a 98.9 percent patient satisfaction score, and saving more than $6K per patient.
Is Your Provider Organization Pursuing HaH?
Hospital-at-Home programs are gaining traction and are well-received by payers. Having a clear plan for clinical care integration, operations, and technology are foundational to success and patient satisfaction. SDLC Partners, as part of the larger CitiusTech organization, delivers top-ranked expertise that drives healthcare innovation.