Introduction
The Centers for Medicare & Medicaid Services (CMS) recently published a comprehensive report comparing the Acute Hospital Care at Home (AHCAH) initiative to traditional brick-and-mortar inpatient care. This study, mandated by the Consolidated Appropriations Act of 2023, explores various metrics such as cost, patient outcomes, and overall experience to evaluate the success of hospital care at home. With the expiration of COVID-era waivers on the horizon, CMS’s findings are critical in determining the future of this healthcare model.
What is the Acute Hospital Care at Home Initiative?
The Acute Hospital Care at Home program was launched during the COVID-19 pandemic as part of an emergency measure to alleviate the burden on hospitals. By enabling patients to receive high-quality hospital-level care in their homes, the initiative aimed to reduce hospital crowding while maintaining or even improving patient outcomes. As of June 2024, 331 hospitals across 136 systems and 37 states were approved to provide acute hospital services at home under this program.
While the initiative was extended beyond the initial public health emergency, it is now scheduled to expire at the end of this year unless Congress acts to extend the waivers. A bipartisan bill, the Hospital Inpatient Services Modernization Act, aims to extend these waivers until 2029.
Key Findings from CMS Study
CMS conducted an extensive study to assess the efficacy of the AHCAH initiative in comparison to brick-and-mortar inpatient care, focusing on key metrics such as mortality rates, readmissions, and hospital-acquired conditions (HACs).
30-Day Mortality Rates
One of the most significant findings from the CMS report was that patients receiving care under the AHCAH initiative generally had lower 30-day mortality rates than their counterparts treated in traditional hospital settings. This finding suggests that home care can be equally, if not more, effective in ensuring patient survival during acute care episodes.
Readmission Rates
When it comes to 30-day readmissions, the results were more nuanced. CMS observed that readmission rates were higher for two Medicare Severity Diagnostic Related Groups (MS-DRGs) within the AHCAH population. However, in contrast, the traditional inpatient group exhibited higher readmission rates for three MS-DRGs, demonstrating variability across different conditions.
Hospital Acquired Conditions (HACs)
The study also evaluated hospital-acquired conditions (HACs), such as infections and pressure ulcers, across six types of HACs. Patients under the AHCAH model experienced lower rates of these conditions compared to those in brick-and-mortar hospitals. However, CMS reported that the differences were not statistically significant, meaning that while trends favored home care, more data is needed to confirm a decisive advantage.
Cost Analysis of Acute Hospital Care at Home vs. Brick-and-Mortar Care
Cost-effectiveness is another key area the CMS study explored. The analysis considered metrics like length of stay, post-discharge spending, and hospital service utilization.
1. Length of Stay: Patients under the AHCAH program typically had a slightly longer length of stay compared to brick-and-mortar inpatients. This could be attributed to the nature of home care, where care providers may opt for a more cautious approach before discharging patients.
2. Post-Discharge Spending: CMS found lower Medicare spending for AHCAH patients during the 30 days following discharge. This indicates that home-based care can reduce costs related to follow-up services, potentially lowering the overall burden on the healthcare system.
3. Service Utilization: The study revealed that AHCAH patients utilized both in-person and telehealth services. While home care episodes generally cost less in the long term, the complexity of patient selection criteria made it difficult to conclusively state that the initiative reduced Medicare spending overall.
Patient Experience in Home Care Settings
One of the highlights of the AHCAH program is the overwhelmingly positive patient and caregiver experience. CMS hosted virtual listening sessions, collected feedback from site visits, and directly communicated with patients and hospital operators. Both patients and their families reported feeling more comfortable receiving care in their home environment, where they could be surrounded by loved ones and avoid the potential stress of a hospital stay.
Clinicians providing care also shared positive feedback, noting that the program allowed for more personalized and attentive care, as they could focus on individual patients without the distractions of a busy hospital ward.
The Importance of Extending Waivers
As the current waivers for the Acute Hospital Care at Home initiative are set to expire at the end of 2024, healthcare professionals and organizations are advocating for their extension. The Hospital Inpatient Services Modernization Act aims to extend these waivers through 2029, providing more time to gather data and improve this innovative model.
The American Hospital Association (AHA) strongly supports this extension, citing the positive outcomes observed in terms of patient care and cost efficiency. With growing support, it remains to be seen whether Congress will pass the bill to extend the program.
Conclusion
The CMS report on the Acute Hospital Care at Home initiative provides valuable insights into the future of home-based acute care. While the initiative shows promise, especially in reducing mortality rates and hospital-acquired conditions, more data is required to assess its long-term impact on costs and patient outcomes.
As healthcare continues to evolve post-COVID, home-based care models like AHCAH could play a critical role in shaping a more patient-centered, cost-effective healthcare system. The decision to extend the waivers will be pivotal in determining the future of this promising program.
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FAQs
1. What is the Acute Hospital Care at Home initiative?
A. The AHCAH program allows patients to receive hospital-level care at home, reducing the burden on hospitals while maintaining high standards of care.
2. What are the key findings of the CMS report?
A. The CMS study found lower mortality rates and hospital-acquired conditions among AHCAH patients, though readmission rates were variable.
3. Will the waivers for the program be extended?
A. The current waivers are set to expire at the end of 2024, but there is support for extending them through 2029.
