CMS releases Acute Hospital Care at Home study

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Patients who receive hospital care at home generally have lower mortality rates than their brick-and-mortar inpatient counterparts, according to a Centers for Medicare and Medicaid Services report on the Acute Hospital Care at Home initiative.

CMS said it's difficult to conclude that the Acute Hospital Care at Home initiative resulted in lower Medicare spending overall as compared to brick-and-mortar inpatient care.

The COVID-19 initiative was extended past the end of the public health emergency, but is scheduled to expire at the end of this year. Congressional action is needed to extend the Acute Hospital Care at Home waivers.

The American Hospital Association supports the Hospital Inpatient Services Modernization Act, a bill that extends the waivers for five years through the end of 2029.

As of June, 331 hospitals, across 136 systems and 37 states, had been approved to provide acute hospital services to patients at home.

WHY THIS MATTERS

The CMS study examined the quality of care for patients treated in the inpatient hospital setting, as compared to individuals with similar conditions and characteristics treated at home. AHCAH patients were found to be meaningfully different from inpatients receiving services furnished by the same hospital facility, CMS said.

In general, AHCAH patients were more likely to be white and live in an urban location and less likely to receive Medicaid or low-income subsidies.

These different characteristics of the AHCAH population may be partially attributable to the inclusion and exclusion criteria developed by participating hospitals for the purpose of identifying patients appropriate for Hospital at Home care, CMS said.

CMS specifically looked at 30-day mortality rates, 30-day readmission rates, and Hospital Acquired Conditions. The study found that beneficiaries who received care under the hospital at home initiative generally had a lower mortality rate than their brick-and-mortar inpatient comparison counterparts.

Results of the 30-day readmissions metric analysis demonstrated some differences, with readmission rates being significantly higher in the acute care at home group for two MS-DRGs, but significantly higher in the inpatient comparison group for three MS-DRGs.

Hospital acquired condition rates observed for beneficiaries served for patients at home were lower than HAC rates observed in the brick-and-mortar inpatient comparison group for all six types of HACs evaluated, though the differences in these rates were not statistically significant, CMS said.

Patients in AHCAH were primarily treated for a relatively small set of conditions. The study found that the most common Medicare Severity Diagnostic Related Groups (MS-DRGs) and Major Diagnostic Categories (MDCs) treated through the AHCAH initiative included respiratory conditions, circulatory conditions, renal conditions and infectious diseases.

COST

The study focused on select metrics, including length of stay per episode, the Medicare spending in the 30 days after hospital discharge and hospital service utilization, including services provided in-person and virtually through telehealth.

The analysis shows that acute care at home inpatient episodes had, on average, a slightly longer length of stay than comparable brick-and-mortar inpatient episodes.

Additionally, there was, on average, lower Medicare spending for services furnished in the 30-day post-discharge period for at-home episodes, as compared to brick-and-mortar inpatient episodes, across more than half of the top 25 MS-DRGs in the acute care at home group.

The differences attributable to hospital at home patient selection criteria and clinical complexity, as measured across the two groups, make it difficult to conclude that the AHCAH initiative resulted in lower Medicare spending overall as compared to brick-and-mortar inpatient care.

PATIENT EXPERIENCE

CMS hosted four virtual listening sessions with patients and caregivers and collected anecdotal information through site visits, direct correspondence with patients and hospital program operators.

Overall, patients and caregivers had positive experiences with the care provided in the home setting. This positive feedback was mirrored by clinicians' experiences providing care to patients at home, CMS said.

THE LARGER TREND

CMS said its study offers new insights and lessons learned for quality improvement efforts for the health and safety of inpatients in the home setting. It also offers opportunities to further develop more targeted measures of cost, quality and utilization.

Acute Hospital Care at Home waivers went into effect during the COVID-19 public health emergency. The Consolidated Appropriations Act, 2023 extended the waivers and flexibilities until the end of this year.

The CAA required CMS to conduct a study and analysis on the initiative and post such a report on a CMS website by September 30. 

Email the writer: SMorse@himss.org