Health systems, hospitals allowed to provide some acute hospital care in patients’ homes

Ingrid Stiver Senior Manager, Health Research Institute, PwC US December 03, 2020

Medicare beneficiaries will be able to be treated in their homes for some acute conditions under a new program rolled out by CMS called Acute Hospital Care at Home (here’s CMS’ press release on it), which will reimburse providers for the care. With over 150,000 new confirmed COVID-19 cases in the US on average each day for the week ended Nov. 29, nearly 100,000 individuals in the US hospitalized with COVID-19 as of Nov. 29, and additional surges in cases and hospitalizations expected in the coming weeks after the Thanksgiving holiday, the additional flexibility to provide some acute hospital care at home likely will be welcomed by providers and Medicare beneficiaries.

CMS acknowledged as much in its press release, stating that patients not diagnosed with COVID-19 may prefer to receive acute hospital care in their home to avoid exposure to the virus. Additionally, in an era of severely restricting visiting policies, these patients may prefer to stay home amid family and friends, the federal agency noted.

That said, some in-person care at the hospital or physician office is required. The program requires that eligible patients be screened in person in a hospital emergency room or an inpatient setting by a physician to confirm that care at home is appropriate. Providers also will be required to assess non-medical factors to confirm that it would be appropriate—and safe—for the patient to receive care at home. For example, these providers should consider social determinants of health, such as whether the patient has working utilities or if there are domestic violence concerns.

CMS’ press release makes it clear that its Acute Hospital Care at Home program is different from traditional home health services. It’s intended for patients who otherwise would be admitted to a traditional hospital, rounded on daily by a physician and requiring a medical team to monitor care needs on an ongoing basis.

Hospitals can apply for a CMS waiver to start providing acute hospital care at home to Medicare beneficiaries. Hospitals that have provided acute hospital care at home to at least 25 patients will be eligible for an expedited review process and will be required to submit monthly monitoring data. Hospitals that treated fewer than 25 patients will be required to complete a more detailed waiver request and submit data weekly.

As part of its announcement of the program, CMS also reported that six health systems with extensive experience providing acute hospital care at home had been approved for the waiver. The agency released a document with statements about the program from five of the six health systems.

In its press release, CMS did not specify how hospital care provided in a patient’s home will be reimbursed or whether this program will end when the COVID-19 public health emergency ends.

HRI impact analysis

The Acute Hospital Care at Home program builds on other regulatory changes made by CMS during the pandemic to address surges of COVID-19 patients and to stop the spread of the coronavirus by providing alternative means of accessing care. This includes allowing for the broad provision of virtual care to Medicare beneficiaries across the country for an expanded list of services, leading to huge increases in telehealth use by Medicare beneficiaries.

It also includes the temporary Hospitals Without Walls program, which is intended to increase hospital capacity by providing services typically supplied in a hospital in other, non-hospital settings and still be reimbursed by Medicare.

Acute Hospital Care at Home allows hospitals to transfer patients to outside facilities for care, including hotels, dormitories and other temporary sites set up for hospital-level care. It allows ambulatory surgery centers and stand-alone emergency departments to contract with local hospitals or enroll with Medicare as hospitals themselves to provide hospital services and bill as a hospital during the pandemic. It also allows care that typically would be provided in a hospital outpatient setting to be relocated to other sites, including patients’ homes, and continue to be reimbursed at the hospital’s on-site rate.

The idea of providing acute hospital services at home is not new and has slowly been gaining momentum for years, as evidenced by the six health systems that received immediate CMS waiver approval because of their experience. It is part of a larger shift from the traditional hospital at the center of the health universe to the patient and their care preferences, including how and when they receive care, at the center—a shift that has been accelerated by the pandemic.

Data from studies of acute hospital care provided at home show that it can save money and produce better outcomes. One study found the adjusted mean cost of an acute care episode to be 38% lower for home patients than patients seen in a traditional hospital and found lower readmission rates within 30 days for home patients.

The new program announced by CMS creates a mechanism for reimbursement that should encourage hospitals to further invest or start investing in the ability to provide acute hospital care at home. As providers plan their post-pandemic strategy, they are considering how virtual care fits into that strategy and may also start weighing how acute hospital care at home, enabled by virtual care, fits into it too.

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Trine K. Tsouderos

HRI Regulatory Center Leader, PwC US

Tel: +1 (312) 241 3824

Ingrid Stiver

Senior Manager, Health Research Institute, PwC US

Erin McCallister

Senior Manager, Health Research Institute, PwC US

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