In 2020, in response to the Covid-19 pandemic, the Centers for Medicare and Medicaid Services (CMS) implemented the Acute Hospital Care at Home Waiver to enable Medicare payment for home hospitalizations for the duration of the public health emergency. While prior to the pandemic there were only about two dozen hospital at home programs across the U.S., a combination of increased need and coverage due to the CMS waiver spurred significant adoption, with 227 hospitals receiving the CMS waiver as of May 2022.
As the public health emergency approaches its end, governments, payers and providers are wondering if to extend the waiver and continue investing in hospitals at home. Here are 7 important benefits of hospitals at home that make hospitals at home valuable investments:
- Promotes health equity– Hospitals at home provide care professionals with the unique opportunity to directly observe patients at their homes and address social determinants of health like food insecurity, medical equipment needs, and management of chronic diseases.
One study in New York City found that for economically disadvantaged patients who qualified for Medicaid or lived in neighborhoods with high-poverty rates, including public housing, hospital-at-home care led to a shorter duration of acute care, and 30-day emergency department revisits not leading to hospitalization were significantly reduced.
- Payers pay less– Most studies have found that hospitals at home generate substantially lower costs, as hospital-at-home programs often involve fewer staff and lower overhead costs, and may also reduce the need for specialized care like intensive care or rehabilitation services. While one study found that the average cost per hospitalization was 38% lower for home patients than in-hospital patients due to “fewer laboratory tests, imaging, and consultation with specialists,” another analysis found that when accounting for all facility, professional and ancillary services, Medicare’s home care reimbursement saves payers over 50 percent of an acute patient stay.
- Better health outcomes– Hospital-at-home care can not only reduce costs, rather, there is strong evidence to suggest that it also generates better outcomes. In a study of 455 patients admitted for pneumonia, exacerbation of chronic heart failure, exacerbation of chronic obstructive pulmonary disease or cellulitis to 3 Medicare-managed care health systems, patients treated in hospitals at home had a shorter length of stay, and some evidence suggested that they even had fewer complications.
Moreover, patients receiving hospital-at-home care “described a locus of control surrounding their sleep, activity, and environmental comfort that control patients lacked,” and were less likely to report disrupted sleep. In addition to better sleep, patients tend to be less sedentary at home. Aside from the added comfort, better sleep and increased physical activity are helpful for healing and recovery. This may help to explain why hospital at home has been shown to reduce readmission rates in several studies.
- Happier patients– In most cases, patients admitted to the hospital want nothing more than to feel better, get discharged and return to their homes. More often than not, if patients can avoid a hospital visit without compromising on quality of care, patients will opt to receive care from the comfort of their own home. It therefore comes as no surprise that patients given the option to do so, report greater satisfaction.
- Reduced readmission rates– For older adults, hospital stays are risky. Aside from being vulnerable to infections and cognitive issues, it is common for patients to lose physical strength that may not be regained due to decreased physical activity, stress or inadequate nutrition. In fact, about one fifth of Medicare patients discharged from a hospital develop an acute medical problem, in most cases one which is different to the index admission, within 30 days that requires an additional hospitalization.
Enabling patients to receive care at home where they are less stressed, more active and in most cases, better nourished, can help reduce the problems associated with hospitalization and thereby reduce readmission rates.
- Freed up space– Of course, allowing patients that are eligible for home care to receive care in their homes, would help hospitals free up time and space for more patients, and alleviate the immense pressures caused by overcrowding. Bed shortages put “pressure on every part of the hospital including its emergency department. If beds cannot be found then ambulances cannot hand over sick patients.”
The NHS is already experimenting with virtual wards to help ease bed shortages by enabling patients to record oxygen, blood pressure and temperature readings from home, inputting readings into an app, which enables medical professionals to monitor their vitals remotely. For patients who still need to be monitored but are ready to be discharged, this is the ideal solution. Implementing more technologies that allow for remote monitoring and care would enable hospitals to free up space and treat patients in the comfort of their homes without compromising on care.
- Increased access to care– hospitals at home can be especially helpful for patients with disabilities or those living in rural or underserved areas. By enabling patients to receive care from home, payers and providers can help patients overcome geographical barriers to care and help bridge care gaps.
While hospitals at home are still in early adoption stages and require the development of virtual hospital systems, they are proving to be promising investments. New technologies are increasing the ease and efficiency with which these programs can be implemented. Supporting these changes through increased coverage can help drive home care into a more developed stage and allow healthcare systems and patients to experience its benefits.
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