Q&A: CMS' extension of Acute Hospital Care at Home indicates potential permanent program

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Healthcare Finance News:  What acute care health waivers issued by CMS during the public health emergency will continue after the PHE expires on May 11? 

Julia Crist: At the end of 2022, CMS extended the Acute Hospital Care at Home (AHCaH) waiver until December 31, 2024. This waiver allows hospitals to provide hospital at home services and bill CMS for the equivalent of an inpatient hospital stay. Hospitals may either avoid an inpatient admission altogether by admitting a patient to home hospital care in the ED, or have a patient finish their hospitalization in the home. 

HFN: What is expected for home health, especially for acute care, after the PHE ends? 

Julia Crist: As it relates to the future of home hospital and home SNF care, the pandemic has proven that care in the home has the same or better outcomes for qualifying patients. Data generated from the 5,000-plus historical Inbound Health episodes show the program cares for patients with high severity of illness yet achieve outsized clinical outcomes. Since the program's inception, the average severity of illness score for the home hospital cohort of patients was 24.3% higher than that of the cohort of patients that were referred to a facility-based care setting. At the same time, the program generated a potentially preventable readmissions score of .91, outperforming brick-and-mortar post-acute care settings. The program has generated an average NPS score of 86, demonstrating that patients and their family members prefer this level of care when clinically appropriate. The financial implications are impressive as well, Inbound Health has shown a reduction in total cost of care by 30-40% on a risk-adjusted basis. 

HFN: What is needed along the lines of regulatory changes, for health systems to continue to offer acute care in the home? 

Julia Crist: The extension of the CMS AHCaH waiver is a strong indication that home hospital and SNF at home will exist as a permanent part of the American healthcare landscape. Regulatory changes we anticipate seeing from CMS include a permanent home hospital program that includes structured compliance and licensing requirements. At Inbound Health, we are strong advocates for measuring the success of a home hospital and home SNF program by its clinical and quality outcomes, while allowing for flexibility in care model and billing entity. For example, under the AHCaH waiver, a hospital must provide two in-person visits per day and monitor medication administration in person. With the very real healthcare staffing shortage, it's an often insurmountable challenge to staff to that level of in-person care and there has not been a demonstrable correlation between outcomes and in-person visits. Additionally, hospitals often do not have the staff or infrastructure to support care delivery in the home environment. CMS has the opportunity to support more rapid expansion of home hospital and home SNF models by including home health agencies as eligible billing entities in the permanent regulation.

HFN: What does the end of the PHE mean for remote monitoring? 

Julia Crist: Inbound Health uses RPM as part of the care delivery model offered in home hospital and home SNF, and the cost of that is included under the CMS waiver program or private payer bundled payment, and so it's not billed as an individual service. RPM direct billing is not my area of expertise, but I understand billable codes for RPM will continue beyond the PHE, but reimbursement rates remain challenging to support a program. 

HFN: What is the expected industry growth for home health outside of acute care? 

Julia Crist: The short answer is that care in the home is growing across all segments (skilled, supportive, medical, hospice, etc.)

Twitter: @SusanJMorse
Email the writer: SMorse@himss.org

Glen Tullman will offer more detail in the HIMSS23 session "Views from the Top: Existential Crisis or Inflection Point Opportunity? An Industry Maverick's Perspective." It is scheduled for Tuesday, April 18, at 3 p.m. – 4 p.m. CT at the South Building, Level 1, room S100 B.