The number of hospitals taking advantage of regulatory flexibility to provide acute hospital services in the home continues to grow. According to a Centers for Medicare & Medicaid Services web page, the program has grown to include 92 hospitals in 24 states.
To take pressure off hospitals during the surging pandemic, the Centers for Medicare & Medicaid Services (CMS) announced in November several steps to increase the capacity of healthcare systems to provide care outside a traditional hospital setting, including in the home. The Acute Hospital Care at Home program is an expansion of the CMS Hospital Without Walls initiative launched in March 2020 as a part of a comprehensive effort to increase hospital capacity, maximize resources, and combat COVID-19 to keep Americans safe. This program creates additional flexibility that allows for certain healthcare services to be provided outside of a traditional hospital setting and within a patient’s home. There are several requirements that a hospital must meet in order to participate in the program. These include:
• Having appropriate screening protocols in place before care at home begins to assess both medical and non-medical factors;
• Having a physician or advanced practice provider evaluate each patient daily either in-person or remotely;
• Having a registered nurse evaluate each patient once daily either in-person or remotely;
• Having two in-person visits daily by either registered nurses or mobile integrated health paramedics based on the patient’s nursing plan and hospital policies;
• Having the capability of immediate, on-demand remote audio connection with an Acute Hospital Care at Home team member who can immediately connect either an R.N. or M.D. to the patient;
• Having the ability to respond to a decompensating patient within 30 minutes;
• Tracking several patient safety metrics with weekly or monthly reporting, depending on the hospital’s prior experience level;
• Establishing a local safety committee to review patient safety data;
• Using an accepted patient leveling process to ensure that only patients requiring an acute level of care are treated; and
• Providing or contracting for other services required during an inpatient hospitalization.
The 92 hospitals participating so far are from 38 health systems. Medical City Healthcare in Texas has 11 hospitals in the program and Cleveland Clinic and Adventist Health in California both have nine.
Many participating hospitals are waiting to see whether CMS, under the new Biden administration, will make the conditions of the waiver permanent.
Some stakeholders say they are seeing an acceleration in higher-acuity home care. Susan Diamond, home care business president at Humana Inc., told Home Health Care News in December: “Physicians are starting to embrace the delivery of hospital-level and skilled nursing care in the home. In the past, physicians were more inclined to refer a patient to a facility setting. Now, given the increased risks, physicians are referring more patients into home-based models, which are able to deliver safe and effective care leveraging home visits, virtual care and remote-monitoring technology, often producing better health outcomes for patients.”
