The explosion of hospital-at-home programs in the U.S. is partly thanks to the Centers for Medicare & Medicaid Services’ (CMS) “Acute Hospital Care at Home” waiver, which will last as long as the public health emergency (PHE) is active.
And it’s not shocking that health systems, hospitals and home-based care agencies helping to facilitate hospital-level care at home are taking advantage of the waiver. What’s more interesting at this point is that, as COVID-19 subsides and the PHE wanes, those same players continue to create and invest in their own hospital-at-home programs.
A very likely reason for that is a belief among health care executives that the waiver will continue beyond the PHE, in some capacity.
Take Norfolk, Virginia-based Sentara Healthcare, for example.
The nonprofit health system launched a hospital-at-home program through its existing hospital pharmacy transition program, “Sentara To Home,” in June of 2020. Sentara serves patients through 12 hospitals and a home health and hospice division.
But it was immediately evident to the organization that the program’s applicability would last long after the PHE.
“Even before COVID, we were thinking about the concept of hospital-at-home. It has always had significant value, but it just hadn’t caught on because there hasn’t really been much payer alignment,” Dr. Colin Findlay, the hospitalist in charge of Sentara To Home, told Home Health Care News. “We were thinking, ‘This is probably something we need to develop as a long-term strategy, [regardless of reimbursement].’”
Even prior to 2020, most of Sentara’s hospitals tended to run at about 80% capacity, so bed flow had been a regular issue.
Then COVID-19 hit, and the projections of in-patient volume were intimidating enough to thrust Sentara into action.
“We took the pieces we had — great hospitals and a great home health service — and we thought, ‘How can we use what we have, and expand our footprint and deliver great care to patients, if we have to go outside the hospital?’” Findlay said. “Then we just got started. We enrolled our first patient last June.”
Even as the health system’s COVID-19 numbers have dropped significantly, its volume of Sentara To Home patients has not. Virginia’s 7-day COVID-19 rate is about 10 times lower than it was when the program was initially launched, according to New York Times data.
And yet, Sentara is about to exceed 200 total patients served through the program over the last year.
Sentara had to be swift with its pilot by necessity when COVID-19 was coming to a head, but then seamlessly began transitioning patients with other conditions into the home.
“It just expanded from there,” Kim Bradley, VP of clinical services, told HHCN. “And we believe that there will be continued expansion.”
Not going away
Bradley’s bullishness on the program’s expansion is telling.
The program was created through a partnership between Sentara Medical Group and Sentara Home Care Services, both of which have a footprint in Virginia and North Carolina. Because it already had a pharmacy transition program to the home for patients, its Norfolk hospital was actually one of the first to be accepted into CMS waiver program.
Since then, the organization hasn’t hit many speed bumps.
“When you look at a measure of success for a program, you want to not only have great outcomes and really good engagement, but you want to have good satisfaction,” Bradley said. “And this program has hit on all of those elements.”
Sentara has home health agencies within the geographic footprint of every hospital in its network. Another clear advantage was not just those capabilities, but also that the relationship between Sentara and its home health care services unit was so strong.
“I think where we had a leg up, if you will, is that we have a strong partnership with our system and with our physician practice groups,” Bradley said. “We had the ability to be able to work through all of the workflows and possibilities by having these other resources available as part of a big team, versus being just a home health provider, and trying to engage those partnerships to be able to make this type of continuum work.”
Sentara has already served 200 patients through the program overall. Its next goal, however, is to be serving 200 patients concurrently in the next few years.
“And there’s probably even more potential than that,” Findlay said. “But that feels like a place where we’d be making a huge impact.”
Released Tuesday, a hospital-at-home report conducted by Ziegler Healthcare Investment Banking suggests that Sentara is not alone in its bullish future outlook for its own program.
“With the CMS waiver in place, interested parties are racing to find their place within the wave of new hospital-at-home participants,” the report read. “This is a primary indicator that the health care industry is optimistic that CMS will codify a long-term solution for hospital-at-home reimbursement; if CMS was unlikely to reimburse for hospital-at-home beyond COVID-19, parties would not be willing to invest time and resources into the program.”
Sentara’s continued investment into Sentara At Home is a clear example of that.
“This is no longer a COVID program, we’ve expanded well beyond that, and we look for appropriate patients that we think will benefit,” Findlay said. “It’s not tied to specific diagnoses, it’s any patient that has stabilized in their clinical pathway, but still needs some elements of hospital care. That’s the type of patient to enroll in the program.”
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