We’re now about one month away from the end of the hospital-at-home waiver that has been keeping the program alive. With the March 31 deadline fast approaching, the push to further extend the program is picking up steam. Earlier this month, in-home care advocacy group Moving Health Home sent a letter to Congress urging the […] The post Case For Hospital-At-Home Gains Strength As Program Expiration Date Looms appeared first on Home Health Care News.
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We’re now about one month away from the end of the hospital-at-home waiver that has been keeping the program alive.
With the March 31 deadline fast approaching, the push to further extend the program is picking up steam. Earlier this month, in-home care advocacy group Moving Health Home sent a letter to Congress urging the inclusion of a five-year extension for the waiver in the March government funding package. Nearly 100 stakeholders signed the letter, including prominent names like AARP, BrightStar Care, Optum, the Home Care Association of America, DispatchHealth and Medically Home.
These groups and other advocates for hospital-at-home have a lot of evidence to point to, regarding the program’s benefits for cost efficiency and patient outcomes. We’ve published several stories over the last few months highlighting these benefits, covering topics such as:
- A survey showing caregiver and patient preferences for hospital-at-home
- A Centers for Medicare & Medicaid Services (CMS) analysis of the program’s effectiveness
- An innovative program involving Mass General Brigham and the New England Center and Home for Veterans
- The importance of change management in making the “complete paradigm shift” to HaH
- The growth of a hospital-at-home partnership involving Contessa, Highmark Health and Allegheny Health Network (AHN)
Given all the activity in Washington D.C. and the furious debate surrounding the Trump administration’s policy priorities and actions so far, advocates for hospital-at-home will have to raise their voices especially loudly to be heard. But the program does appear to have bipartisan support and some leaders in the space are optimistic.
In this week’s exclusive, members-only HHCN+ Update, I examine this issue and offer key takeaways, including:
- What points are central in the argument to extend the hospital-at-home program
- How providers are implementing HaH to ensure quality of care and cost savings
- How tech-driven efficiencies make HaH an increasingly obvious choice to be an enduring health care delivery model
A bridge to a permanent model
As of November 2024, 378 hospitals in 39 states were approved to provide HaH services, according to the American Hospital Association.
In December 2024, the Biden administration signed a spending bill that temporarily extends the waiver for the popular program to March 31. Now, a variety of stakeholders are pushing for an additional five-year extension, signing on to the Moving Health Home letter.
“Americans want home to be the center of their health,” Moving Health Home wrote in the letter. “Federal flexibilities such as the waiver allowed hospitals to do just that. Another extension of the waiver effectively builds the bridge from demonstration to a more permanent model by giving more certainty to those hospitals currently on the sidelines waiting for regulatory clarity. The evidence is mounting; another extension will continue the progress and expand participation.”
In January, we published highlights from my conversation with Dr. Stephen Dorner, chief clinical and innovation officer at Boston’s Mass General Brigham (MGB) Healthcare at Home; he expressed support for the continuance of the model and had confidence that Congress would continue its trajectory.
“I am confident that Congress recognizes the substantial bipartisan support observed during the recent continuing resolution negotiations,” Dorner said. “As they reconsider this issue before its expiration in March, I anticipate a longer waiver extension that will provide the necessary runway for new market entrants and encourage more significant investments in this space in the future.”
The themes of accessibility for patients, cost savings for health care systems and an easing of staffing burdens have repeatedly risen in HHCN stories throughout the last few months, and they are key elements that supports can – and are – pointing to as they make the case for the program’s extension and expansion.
Patient accessibility and satisfaction
In October 2024, CMS released a report demonstrating that HaH is a safe, effective program and that these patients had lower mortality rates, readmission rates and spending in the 30 days post-discharge. Patients and caregivers have also expressed positive experiences with the program.
This accessibility and satisfaction were highlighted when I spoke with Dr. David Levine, MGB’s clinical director for research and development, about an innovative collaboration between MGB and the New England Center and Home for Veterans (NECHV).
“Experiencing homelessness has traditionally excluded individuals from our program and most HaH initiatives,” Levine said. “This is an opportunity to change that. The goal is to intervene during a critical time in a patient’s life when they are both homeless and critically ill. Many of these individuals get caught in a cycle where illness leads to the loss of their belongings or their place in semi-permanent housing.”
While the MGB team ensures that a patient’s medical issues are appropriately addressed, NECHV provides housing and additional support, ensuring that the veteran’s services are not interrupted during their hospitalization at the center. This ensures veterans receive the care they need where they are without the concern of losing what little they have.
Contessa, Highmark Health and Allegheny Health Network (AHN) also partnered to prove out the value of delivering more acute care in the home.
The partnership culminated in the launch of a home-based acute care model for Highmark health plan members. Since its launch in 2020, the model has adapted to offer hospitalized patients an alternative to skilled nursing and rehabilitation facilities after discharge.
“Our patient satisfaction surveys reveal high levels of contentment among those recovering at home,” said Dr. Vicenta Gasper-Yoo, senior vice president of care continuum and transitions at AHN. “Leaders received numerous positive messages from patients who appreciated recovering at home with their families, reinforcing our decision to expand this program. We cannot expand our inpatient units without incurring hundreds of millions of dollars; therefore, this is the most viable option. Moreover, reduced infection rates and fewer readmissions drive our program’s growth.”
Another advantage is increased staff satisfaction and retention.
“Acute care nurses working in home settings report significant satisfaction due to the flexibility of spending quality time with their patients, which is impossible in traditional inpatient settings,” Dr. Michael Nottidge, senior vice president and national medical director at Contessa, said.
He explained that nurses in facilities often face interruptions and have limited time for patient interaction. In home care, they can bond, educate and make meaningful impact on patients, often delivering concierge-type care.
“Patient satisfaction levels in these models have consistently been high,” Nottidge said. “Payers are on board with this approach. Patients receive numerous benefits: they remain in their homes, and they tend to be more functional post-discharge, making it hard to argue against this model.”
Patient safety and quality of care
Research indicates that patients needing care prefer to receive it in their homes rather than in a hospital setting. Health care models like HaH facilitate this preference, and findings from a CMS study evaluating several aspects of the HaH model, published in September 2024, suggest that it is safe to do so without compromising quality.
The study used available data to compare patients in HaH care with those in traditional hospitals. This involved 332 participating hospitals across 38 states and covered the period from November 2020 to July 2024. The data analysis focused on patient inclusion criteria and demographics, clinical conditions treated, quality of care, costs and service usage and patient experience.
The study used the Medicare Severity Diagnosis Related Group (MS-DRG) and Major Diagnostic Category (MDC) classification systems to identify the most common illnesses treated under the HaH model. The findings indicated that the predominant conditions were respiratory, circulatory, renal and infectious diseases.
Three quality metrics – 30-day mortality rates, 30-day readmission rates and hospital-acquired condition rates – were analyzed to compare the quality of care. It was found that HaH patients generally had lower 30-day mortality rates than their counterparts in traditional inpatient settings, according to CMS.
However, those in HaH care did experience slightly higher readmission rates for two specific MS-DRGs – respiratory infections and inflammation requiring mucociliary clearance, as well as septicemia or severe sepsis without mechanical ventilation. Conversely, readmission rates were significantly lower for three other MS-DRGs – simple pneumonia and pleurisy with complications or comorbidities, or the need for mucociliary clearance, and chronic obstructive pulmonary disease with complications or comorbidities.
CMS data on patient experiences under the HaH initiative also indicated that both patients and caregivers who shared their feedback had positive experiences regarding the care provided. Clinicians also reported primarily positive experiences.
This study suggests that providers can deliver safe, high-quality inpatient care in home settings for appropriately selected patients. This approach aligns with and supports the CMS Center for Clinical Standards and Quality’s core mission of enhancing lives, health outcomes and care experiences.
Technology makes HaH an obvious choice
The benefits of HaH care translate into significant interest and energy from caregivers and leaders who want to change the paradigm of how and where care is delivered, according to Dr. Dorner. As a result, there is constant innovation. Medtech companies are stepping up to enable care delivery through modular and portable technologies used in the home setting.
Looking ahead, Dorner said the goal is to leverage the data being collected through these technological modalities and across the various stakeholders in the HaH space. This will allow for a shift from a reactive to a proactive and predictive perspective in health care.
“By using artificial intelligence (AI) and other tools, we can anticipate patients’ care needs and intervene in their homes, preventing situations that require facility-based care and helping them heal and improve within their home environments,” he said.
Mobile diagnostics are also entering the scene.
DocGo, a provider of technology-enabled mobile health services, recently announced the acquisition of PTI Health, a mid-Atlantic mobile lab collection and phlebotomy services company.
PTI Health serves homebound patients and their clinicians. The company’s mobile phlebotomists perform in-home blood draws and other collections, enabling seamless diagnostics and care gap closure in collaboration with patients’ health care providers. This, and other services like it, are ensuring a seamless care continuum that focuses on keeping patients in the home while receiving hospital-level care.
In other words, the evolution of technology should mean that HaH will have increasing benefits over time. Of course, if the program expires, that will be a huge setback to the ongoing maturation of hospital-at-home. Even a temporary halt in the program will cost providers valuable time in which they could have been refining their models and learning the best ways to integrate new technologies for maximum effectiveness.
So, I expect and hope that the chorus of voices advocating for HaH will keep gaining strength and volume in the days and weeks ahead.
“It’s important for providers to write and call their senators and representatives to let them know they want their support for the continuation of the Acute Hospital Care at Home Waiver,” Dorner said. “When you look at the traditional health care landscape, the growing demand for access, and the ever-longer wait times for care, it’s clear that the status quo is unsustainable. We need new solutions to deliver better care, and HaH is our greatest promise to realize a better future in care delivery.”
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