A federal report to Congress on the Acute Hospital Care at Home initiative shows that at-home acute care produces lower mortality rates and post-discharge spending than traditional inpatient care while also yielding positive feedback from patients and caregivers.
The Centers for Medicare & Medicaid Services (CMS) launched the home-care initiative in response to the COVID-19 public health emergency, granting waivers to individual hospitals to provide Medicare patients with inpatient-level home care. With 358 approved hospitals across 137 health systems in 39 states since its start in November 2020, this innovation in care delivery has become an important feature of the Medicare program.
The Consolidated Appropriations Act of 2023 extended the Acute Hospital Care at Home initiative beyond the pandemic’s emergency period through Dec. 31, 2024. The AMA supports legislation (PDF) that would extend the program for an additional five years.
Innovations in policy and technology have allowed home health programs to progress in recent years, expanding the offerings in acute, chronic, preventative and end of life care.
Demand for these services has kept pace. “As the population of older adults in the United States continues to grow, the demand for health care services that enable them to age in place is becoming increasingly important,” according to an AMA report, “The State of Health at Home Models: Key Considerations and Opportunities” (PDF). Two-thirds of the U.S. population between 60 and 79 years of age want to stay at home in their later years, reports the Linus Group.
Importantly, these programs demonstrate clinically, and often more cost-effective care. “Numerous studies have demonstrated that many types of care that are currently delivered in an office or facility could be provided at home, with clinically appropriate, high quality, and cost-effective outcomes,” wrote the authors of the AMA report. About 15–20% of emergency and urgent care services and up to 35% of hospice services are capable of being administered at home. As home care continues to evolve, this service could provide up to 25% of post-acute and long-term care in the home.
Home care reduces mortality, spending
CMS wanted to examine the quality of care provided by Acute Hospital Care at Home in comparison with traditional inpatient hospital care.
The report’s authors compared clinical conditions, Medicare Severity Diagnostic Related Groups (MS-DRGs) and diagnoses from Acute Hospital Care at Home episodes to inpatient episodes from the same hospitals. Respiratory conditions, circulatory conditions, renal conditions, and infectious diseases were among the most common of Acute Hospital Care at Home’s 25 DRGs.
Specifically, researchers assessed rates of 30-day mortality, 30-day readmission and hospital-acquired conditions across Acute Hospital Care at Home and inpatient episodes. They also compared cost, utilization and patient experience of care.
Nevertheless, Acute Hospital Care at Home populations had lower mortality rates than their brick-and-mortar inpatient counterparts. “The mortality rate for AHCAH [Acute Hospital Care at Home] inpatients was lower for all top 25 MS-DRGs, and for 11 of those top 25 MS-DRGs this difference was statistically significant,” says the CMS report.
The Acute Hospital Care at Home population also had lower hospital-acquired infection rates, although CMS reported that the differences among the two groups weren’t statistically significant.
Thirty-day readmission rates produced mixed results, with the at-home group yielding significantly higher rates for two MS-DRGs, compared with very high rates for three MS-DRGs for the inpatient group.
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At-home care reduces costs
Cost and utilization metrics included length of stay per episode, Medicare spending in the 30 days after hospital discharge, and hospital service utilization.
Acute Hospital Care at Home episodes were associated with lower Medicare spending in the 30-day post-discharge period across more than half of the top 25 MS-DRGs, compared to traditional inpatient episodes. CMS issued a caveat that “the differences attributable to AHCAH 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.”
Acute Hospital Care at Home inpatient episodes on average had a slightly longer length of stay, however.
Overall, “the information collected and detailed in the study suggests that patients and caregivers had positive experiences with the care provided in the home setting through the AHCAH initiative,” CMS reported in its fact sheet on the findings.
Extend hospital at home through 2029
The AMA has commended leaders of the House Energy and Commerce Committee for including an extension of the Acute Hospital Care at Home waiver flexibilities through 2029 as an amendment to H.R. 7623, the Telehealth Modernization Act of 2024. The measure has bipartisan support in the House and Senate.
Extending this flexibility for five years will “allow home-based services to be developed equitably across populations everywhere and ensure hospital inpatient unit care is available for the patients who need it while enabling patients who can and want to be treated in their home to have the opportunity to do so, creating needed capacity for hospitals without increasing health system costs,” wrote James L. Madara, MD, the AMA’s executive vice president and CEO, in a letter to lawmakers (PDF) that urges passage of the amended bill.
This recent report of the program’s positive marks on savings, outcomes and patient satisfaction ought to bolster support for Congress to act before the end of the year.
