The Centers for Medicare & Medicaid Services (CMS) gave health systems and providers the ability to take hospital at home as a concept and run with it during the public health emergency (PHE).
Those providers did so, and now they’re wondering what comes next. With regulatory uncertainty moving forward, the hospital-at-home momentum has been put on pause – but not because of patient preference or provider enthusiasm.
“There is over 250 hospitals and 100 health systems across 30-plus states that have now been granted CMS waivers,” Biofourmis CMO and co-founder Maulik Majmudar said on a Moving Health Home webinar Tuesday. “However, it is also clear that a sizable part of the country does not have any offerings today. And more importantly, the number of CMS waivers granted in the last few months has been on a decline.”
The Boston-based Biofourmis is a tech-enabled at-home care enabler. The startup recently reached unicorn status.
Indeed, there are plenty of hospitals that have been approved to provide hospital-level care in the home under the CMS waiver. But many have not begun to do so given the regulatory cliff they face. The Acute Hospital Care at Home waiver is tied to the PHE, which could be ending by the end of this year.
Some health systems have found other mechanisms to provide hospital-at-home care independent from the waiver. There is also introduced legislation that would extend the Acute Hospital Care at Home waiver by two years past the PHE. But nothing yet has been set in stone.
And thus leads to the halted momentum: only two hospitals in the country have treated more than 2,000 patients under the hospital-at-home waiver, according to Majmudar.
“The key point is that there’s a lot of opportunity and room for technology to drive both safe and effective deployment of these programs, but especially in a way that allows us to achieve scale,” he said.
The resulting hesitation from the regulatory holdup has spurned innovation, and also providers’ ability to learn from their mistakes on the fly as they scale.
At the same time, there are health systems – like Advocate Aurora Health, for example – that love the opportunity to provide this care in the home, but not exactly as its allowed right now under the waiver.
“We certainly support the continuation of the waiver,” Dawn Doe, the VP of value-based programs and continuing health at Advocate Aurora Health, also said on the webinar. “But we ask for more flexibility on the structure, and the entities that can provide the program, for us as an integrated health system.”
For instance, as currently constituted, the waiver makes it so Advocate Aurora Health is forced to have its 27 hospitals all have different hospital-at-home programs.
That, Doe said, just doesn’t make sense for Advocate Aurora based on how it’s structured.
“We would like to see reimbursement models that really provide patients the ability to stay in their home while avoiding expensive institutional care,” Doe said. “And that the waivers for telehealth and remote monitoring reimbursement be made permanent. This not only improves patient outcomes, but will also address the strain on staffing resources.”
Home health providers’ involvement
New reimbursement models for hospital at home and staffing elements of the programs are top of mind for all providers.
In order for a new reimbursement vehicle to come out of CMS, the next step would be a demonstration project, which Moving Health Home and others are advocating for.
On the staffing front, there have actually been encouraging signs that employees enjoy working in the confines of a hospital-at-home program.
“These types of models really help us lean into those needs for our nursing staff,” Jordan Holland, the VP of value-based contracting at Compassus, also said on the webinar. “We’re able to attract and engage nurses – to keep them from potentially leaving the industry – through new innovative models like this.”
The Brentwood, Tennessee-based Compassus offers home health care services, plus infusion therapy, palliative care and hospice care. Its network includes about 200 locations across 30 states.
Compassus is an example of a traditional home-based care provider that’s gotten its hands on the hospital-at-home business, a good sign for others that may want to do the same.
To date, the company has cared for over 600 patients in a hospital-at-home model.
“What really keeps me up at night, in particular, is making sure that there’s an appropriate reimbursement model to support this level of staffing and this level of comparative productivity to a typical home health model,” Holland said.
Companies featured in this article:
Advocate Aurora Health, Biofourmis, Compassus, Moving Health Home
