Program Helps Providers Care for More Patients During Pandemic

NEW YORK (Reuters Health) – The “hospital at home” (HaH) program, established during the COVID-19 pandemic, enables necessary medical care for more patients by providing acute hospital care in their homes, researchers write in a new report.

In November 2020, to expand access to hospital care during the COVID-19 pandemic, the Centers for Medicare and Medicaid Services (CMS) announced the Acute Hospital Care at Home (AHCaH) individual waiver.

“This waiver allows hospitals to get reimbursed in the same way as traditional inpatient care for patients cared for in hospital at home,” Dr. Linda V. DeCherrie of the Icahn School of Medicine at Mount Sinai, in New York City, who worked on the study, explained in an email to Reuters Health.

While the program waives the need for around-the-clock onsite nursing, hospitals in the program must follow all other program requirements, commit to providing hospital-level care in patients’ homes, and regularly report their outcome data to CMS.

“With more hospitals offering acute care at home, more patients will have the opportunity to receive the benefits that this care model affords: less readmission, more physical activity, and high patient experience,” lead author Dr. David M. Levine of Harvard Medical School in Boston, Massachusetts, told Reuters Health by email. “Hospitals continue enrolling in the waiver. Between publication of our study and present day, another 40 hospitals have been approved.”

To investigate the types of hospitals that participated in the program, the two researchers and their colleagues analyzed data from the AHCaH CMS dashboard. They linked hospitals holding a waiver with the American Hospital Association 2019 Annual Survey.

Between November 2020 and July 2021, 144 hospitals in 66 health systems in 32 states were approved for AHCaH individual waivers, the team reports in Annals of Internal Medicine. Of these, 79% were nonprofit hospitals, 56% were minor teaching hospitals, 92% were metropolitan hospitals, 51% had more than 299 beds, and 23% owned their own home-health agencies.

“We know that thousands of patients are now receiving this care,” Dr. Levine said. “Home hospital needs to be part of the pandemic playbook, as a complement to things like field hospitals.”

Delaware (40%), North Carolina (16%) and South Carolina (16%) had the highest percentages of waivers. Participation was rapid among large hospitals (8.9%), metropolitan hospitals (4.5%), and major teaching hospitals (13.2%). By contrast, few hospitals that were rural (0.09%), had fewer than 100 beds (0.8%) or lacked teaching programs (1.0%) received a waiver.

The authors write that limited resources to launch new care models at rural hospitals and requirements for patients to live within a certain distance of the hospital may limit the program’s feasibility in rural communities.

They point to other potential barriers to uptake, including hesitancy of hospitals and health systems to commit to a program that may be temporary, limited resources, state regulations, and uncertainty about payment mechanisms for private payers. They recommend related research, and technical assistance where needed.

The study did not receive commercial funding, and the authors report no conflicts of interest.

SOURCE: Annals of Internal Medicine, online October 26, 2021.

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