The immense burden Covid-19 placed on U.S healthcare systems pushed CMS to go ahead, use their emergency authority and waive several regulations that impact the ability to offer “hospital at home” or “SNF at home” services. The Centers for Medicare and Medicaid Services offered flexibilities, so that acute hospital care could continue despite hospitals being strained during and after the pandemic. The waiver itself was prompted by the pandemic, as hospitals were already strained and so health systems are looking for solutions that could more effectively cater to patient needs.
The AHCaH Initiative Finds Ground
The Acute Hospital Care at Home (AHCaH) CMS program was launched in November 2020: this permitted Medicare-certified hospitals to provide hospital-level care to patients in their homes. The AHCaH program was the outcome of rigorous consultations between private-sector industry leaders and members of the academic community. This was done to make sure that the needed safeguards were in place that would ensure patient safety.
Statistics support the success of this program. As of October 2021, this had been implemented by 186 hospitals all over the U.S and these services successfully reached 1,878 patients. Hospitals have provided positive feedback to CMS on their experiences with the AHCA waiver.
Actual Experiences with Healthcare at Home Programs?
As reported in Fortune, in May this year, George Hardy stopped by the emergency department of the Massachusetts General Hospital in Boston. He was diagnosed with congestive heart failure and stayed at the emergency department for the next 24 hours. Afterwards, he left for home but he never left the hospital.
How can that be the case? Hardy was instead admitted to Mass General Brigham via its Healthcare at Home Program while being at his own house in Somerville. Hardy received the same level of care he would have typically received at a hospital: daily nursing checks, provider visits, physical assessments and medications for the treatment of his condition. This was the case, with just one difference. Hardy rested in his own bed, was moving around in his own house and had his cat, Emma and his parakeet, Fritz right with him. He was a patient nonetheless, but one that didn’t require his family driving up to the hospital to see him.
In his own words,
“I really loved to have treatments at home. When I was in the hospital, my doctor told my family he’s going to get just as good or better service at home. She was right. I had a better time at home.”
The idea of a “hospital-at-home” system in the United States however, is only gradually gaining momentum due to lack of funding. Currently, the waiver extension offers reimbursement for home hospital care through CMS, and this is all set to expire on December 31st, 2024. The progress this emerging form of care has made will only hold if the federal government enables hospital-at-home care by another waiver extension. Many clinicians and researchers are working to convince the federal government that full CMS coverage or the waiver extension will benefit everyone.
This mode of care has produced equal outcomes in comparison to the traditional form of inpatient care in the following areas: hospital readmissions, mortality, total cost, average length of stay and patient satisfaction. Patient satisfaction, however, comes as no surprise, as most of them have a strong preference for getting treatment within the comfort of their homes. One meta-analysis from 2017 suggested that the hospital-at-home model was linked with lower mortality rates, hospital readmissions, costs and increasing levels of satisfaction among both patients and providers.
Once they have experienced this, most of them don’t want to be a part of facility-based care again. Obviously, no one is saying that all care can be provided while being at home because it most certainly can’t. This however, does not mean we should shy away from the benefits that home-based care delivery has to offer.
Despite everything, the “hospital-at-home” model worked for 84-year old George Hardy and this makes the conversation around this much simpler. The real question now is, whether the U.S federal government sees enough value in this to throw its full support behind this program.
The Rising Demand for Robust Digital Healthcare Support
The pandemic definitely brought forward the need for there to be a more robust and flexible digital health platform that goes all the way from the doctor’s office to the patient’s home. The concept of care-at-home programs have been around for quite some time, and now we have the tools and the technology to speed up its adoption across the country. Major market forces also support this trend. Industry bigwigs like Intermountain Healthcare, LifePoint Health, the Mayo Clinic and Kaiser Permanente have implemented joint initiatives that go beyond the hospital.
In fact, providers are implementing improved communication platforms to support this work, at an increasing pace. Hucu.ai offers hospital at home programs the best in class patient-centered communication that enables providers to manage real time communications and keep the entire team informed seamlessly. Traditional hospital EHRs are insufficient for the level of care coordination required, particularly when collaborating with home healthcare and other community based service providers.
The Pandemic Spurred a Great Deal of Innovation.
Over a decade ago, CMS started experimenting with new value-based healthcare payment models. Around the same time, innovations in digital health led to a modest adoption of digital technology such as telehealth, remote patient monitoring equipment and so on. The interest was there but it had not yet reached its tipping point. The pandemic changed all of this. It highlighted what happens when hospitals are pushed to their limits and accessing care is no longer that easy. Therefore, the healthcare industry saw digital tools as a necessity and began to adopt and expand their use outside of the hospital setting to deal with the healthcare crisis.
Technological advancements will help accelerate this trend and make it easier for more acute conditions to be treated under this model. Over the last year, we have seen that more people have been accepting of healthcare at home and so, this model will stand the test of time.
Sources
Acute Hospital Care at Home: The CMS Waiver Experience
Where Hospital-At-Home Programs Are Heading After Last Year’s Boom
CMS Waivers, Flexibilities, and the Transition Forward from the COVID-19 Public Health Emergency
