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Acute Hospital Care at Home data released听

For the program to continue into 2025, legislative action is needed.

Susan Morse, Executive Editor

Photo: David Sacks/Getty Images

The Centers for Medicare and Medicaid Services is releasing data on the Acute Hospital Care at Home initiative through the Research and Data Assistance Center.

ResDAC collected from November 27, 2020, through March 30, 2023. As required for participation, hospitals agreed to report to CMS either weekly or monthly.听

The Acute Hospital Care at Home program was among the flexibilities CMS allowed during the public health emergency as a Section 1135 waiver.听

The expiration of the COVID-19 public health emergency in May 2023 ended many of the waivers. Others that were shown to be successful both for patients and hospitals remained in place under the Consolidated Appropriations Act of 2023. The CAA extended waivers and flexibilities associated with telehealth and also for the Acute Hospital Care at Home program until December 31, 2024.

CMS said the Consolidated Appropriations Act requires specific data collection for the purpose of conducting a study. Continuation of the AHCAH initiative beyond December 31 is contingent on further Congressional action, CMS said.

Both patients 鈥 and hospitals that have the scale to establish acute care at home programs 鈥 have reportedly liked the program. Hospitals found a financial advantage to transferring lower acuity patients to the home, freeing up beds for sicker patients.

Whether hospital investments in the program will bring ROI long-term depends on a "Super Bowl" of legislative policy decisions this year.

"With nearly all of the flexibilities established during the COVID-19 public health emergency extended until the end of 2024, we can expect a telehealth policy 'Super Bowl' at the end of next year," American Telemedicine Association SVP of public policy Kyle Zebley said in November,听

WHY THIS MATTERS

As of March 20 of this year, 277 hospitals across 123 systems in 37 states were approved to participate in the Acute Hospital Care at Home program, according to CMS published in November 2023 in the Journal of the American Medical Association.

From November 25, 2021 through March 20, 2023, 11,159 patients were admitted into the program. The most common conditions treated, based on the primary diagnosis, were respiratory infections, heart failure and shock, and severe sepsis or septicemia, all with a major complication and comorbidity.

For Medicare patients, the median length of stay was five days. The overall proportion of patients transferred from home back to the hospital was 7.2%.

During the study period, 38 unexpected deaths (0.34%) occurred in participating hospitals. Most unexpected deaths occurred in the setting of COVID-19 infection with the progression of more severe illness symptoms.
With the exception of three cases, each of the patients who died had been transferred back to the hospital and received medical or intensive care unit鈥 level care for several days prior to death.

THE LARGER TREND

CMS launched 听the Acute Hospital Care at Home initiative in November 2020 in response to challenges faced by hospitals because of the spread of COVID-19. CMS allowed certain Medicare-certified hospitals to treat patients with inpatient-level care at home using Section 1135 waivers of the Social Security Act.

Acute Hospital Care at Home expanded on the broader "Hospital Without Walls" initiative. It allowed hospitals to seek waivers suspending the requirements for nursing services to be provided on premises 24 hours a day, seven days a week, and for a registered nurse to be immediately available.听

Hospitals providing care in patients' homes continued to meet all health and safety requirements that were not waived through the public health emergency waiver authority under Section 1135 of the Act.听

Email the writer: SMorse@himss.org