How hospital-at-home has performed so far

In a new report, CMS evaluated home-based acute care delivered at 332 hospitals nationwide. The report was a requirement of the Consolidated Appropriations Act of 2023 and could influence lawmakers as they decide whether to extend the Acute Hospital Care at Home program, which is set to expire at the end of December.

According to the report, the majority of patients participating in hospital-at-home (HaH) programs were white, lived in urban areas, and were less likely to be on Medicaid. According to CMS, the demographic differences were likely due to guidelines developed by hospitals to identify potential patients.

The most common illnesses treated in the programs were respiratory, circulatory, and renal conditions, as well as infectious diseases. Other common conditions included congestive heart failure, acute asthma exacerbation, urinary tract infections, and pneumonia. Hospitals typically limited home-based acute care to patients with certain conditions.

The report found that the quality of care through the programs was mixed overall. Patients who received care at home typically had lower mortality rates across the top 10 treatment conditions compared to those who received facility care. Patients with less complex respiratory and infectious illnesses also had better 30-day readmission rates with HaH care than facility care.

However, patients treated at home for more complex conditions related to respiratory infections had higher hospital readmission rates. There was also little difference in readmission rates for patients treated at home for heart failure and shock and those treated in hospitals.

Although HaH patients had a slightly longer length of stay than in-facility patients, they had lower Medicare costs for services in the 30 days after their discharge. However, CMS noted that differences in patient selection and clinical complexity made it difficult to determine if the program resulted in lower Medicare spending overall.

Overall, patients and caregivers were satisfied with the care they received at home, with patients saying they felt more comfortable and less anxious about their care. Caregivers also said they felt less stressed when they could be in a familiar setting with their family members.

Commentary

According to Advisory Board's Jared Landis, reimbursement remains a barrier to broader adoption of home-based care, but it is "not a silver bullet that guarantees scaled adoption of home-based models" due to the logistics of transitioning from a facility-based delivery system to a home-based one.

Advisory Board's Miriam Sznycer-Taub agreed, saying "HaH and home-based care open up providers to a whole host of new challenges of how to deliver facility-level care in a patient's home" and that "just providing a reimbursement structure doesn't solve for those."

Both Landis and Sznycer-Taub also noted HaH and home-based care may just add another site-of-care option for people who already have good access to care, especially since the patients in CMS' report were largely higher-income, white patients.

"[W]hile I've heard anecdotally from health systems who claim that HaH helps with equity issues — this shows that the way you construct a program (through your inclusion criteria) has a huge impact on who gets access," Sznycer-Taub said.

However, with patient satisfaction high with HaH and other home-based models, Landis said that it's important to figure out how to let individuals remain in their homes as much as possible when and where it's safe and appropriate.

"That's not just about HaH — it's about better primary care/wellness that keeps people health initially, better efficiency to get patients discharged from facility-based care to home, [and] better solutions to caregiver problems in the country — but facility-based care substitutes (such as HaH) should also be part of that push," Landis said. (Eastabrook, Modern Healthcare, 10/4)

Use our decision guide to help determine whether you should launch or expand a Hospital-at-Home program.