A study released today by researchers at Mass General Brigham focuses on the safety and quality of care in the Hospital at Home program, which will be discussed in at least one panel session at this week’s CES 2024 show in Las Vegas.
Advocates are touting a first-of-its-kind national study of Hospital at Home outcomes to convince the Centers for Medicare & Medicaid Services to make reimbursements permanent.
The study, led by researchers at Mass General Brigham and funded by the National Institutes of Health, analyzed clinical outcomes for almost 5,900 patients who were treated in CMS-approved Acute Hospital Care at Home (AHCaH) programs across the country. The research, posted today in the Annals of Internal Medicine, found that those patients saw a lower mortality rate than if they were hospitalized, incurred fewer rehospitalizations, and spent less time in a skilled nursing facility (SNF).
[See also: Patient Experience is Crucial to the Success of Hospital at Home.]
More than 300 health systems and hospitals have launched Hospital at Home programs since CMS created a waiver for the program in 2020, enabling health systems who follow the agency’s guidelines to qualify for Medicare reimbursements. Other health systems have developed their own acute care at home programs, aimed at reducing stress on inpatient services and giving patients an opportunity to recover more quickly and effectively at home.
The study helps advocates who are lobbying CMS to make the AHCaH waiver, which is scheduled to expire at the end of this year, permanent. Many health systems are dependent on the waiver to sustain their programs, and are struggling to expand or develop long-term plans with the threat of losing that reimbursement.
The Mass General Brigham study was led by David Levine, MD, MPH, MA, clinical director for research and development for Mass General Brigham’s Healthcare at Home, one of the first to develop an acute care at home program and study its benefits.
[See also: Mass General Brigham Expands its Hospital at Home Program.]
“For hundreds of years, since the inception of hospitals, we’ve told patients to go to a hospital to get acute medical care,” Levine said in a Mass General Brigham press release issued today. “But in the last 40 years, there’s been a global movement to bring care back to the home. We wanted to conduct this national analysis so there would be more data for policymakers and clinicians to make an informed decision about extending or even permanently approving the waiver to extend opportunities for patients to receive care in the comfort of home.”
Levine and his colleagues analyzed Medicare fee-for-service Part A claims filed between July 2022 and and July 2023 for 5,858 patients across the country who had been treated in AHCaH programs. Of that group, roughly 42.5% were being treated for heart failure, 43% for COPD, 22% for cancer, and 16% for dementia. The mortality rate for that group was 0.5%, the escalation rate (returning to the hospital for at least 24 hours) was 6.2%, and within 30 days of discharge, 2.6% used an SNF, 3.2% died, and 15.6% were readmitted.
“Home hospital care appears quite safe and of high quality from decades of research — you live longer, get readmitted less often, and have fewer adverse events.” Levine said in the press release. “If people had the opportunity to give this to their mom, their dad, their brother, their sister, they should.”
Levine also noted that the study found no differences in outcomes for underserved patients, indicating the program could help address some of the barriers that patients face in accessing care.
“There are a number of reasons we think hospital-level care is better at home,” he said. “For one, the discharge process is smoother since we show patients how to take care of themselves right in their homes, where they are also more likely to be upright and move more. In addition, the clinical team has a greater ability to educate and act on the social determinants of health that we see in the home. For example, we can discuss a patient’s diet right in the kitchen or link a patient with resources when we see the cupboards are bare.”
Levine’s colleague, Jared Conley, MD, PhD, MPH, associate director of the Healthcare Transformation Lab at Massachusetts General Hospital, said during a HealthLeaders virtual summit in 2023 that the Hospital at Home program could eventually surpass inpatient care as the highest quality acute care program. The challenge, he said, lies in balancing in-person care with virtual and digital health technology to achieve the best results.
"Think of this as building another brick-and-mortar hospital," he said. "It is very challenging work, but it is so beneficial."
The Hospital at Home concept will be discussed during a panel at this week’s 2024 CES event in Las Vegas. Conley will be taking part in a Thursday panel titled Revolutionizing Health Through Smart Home Innovation, which will be moderated by HealthLeaders Senior Editor Eric Wicklund.
Eric Wicklund is the associate content manager and senior editor for Innovation at HealthLeaders.
KEY TAKEAWAYS
More than 300 health systems and hospitals have launched CMS-approved Acute Hospital Care at Home (ACHaH) programs since 2020, when CMS created a waiver to enable hospitals to qualify for Medicare reimbursement.
A new study by researchers at Mass General Brigham, one of the first health systems to launch a Hospital at Home program, finds that patients across the country that have been treated in the program are seeing lower mortality rates and fewer returns to the hospital and spending less time in a SNF.
The study supports a lobbying campaign by advocates to make the CMS waiver, which is scheduled to expire at the end of this year, permanent.