Hospital-at-home programs hit speed bumps

modernhealthcare.com

October 29, 2024 9:34 am

Some health systems are pausing, scrapping or delaying the launch of hospital-at-home programs despite a broader industry push to provide more healthcare in the home.

Health systems such as Tufts MedicineFranciscan Health, Cone Health and UCSF Health pointed to high costs, a shortage of eligible patients and regulatory uncertainty as driving their decisions to curtail home-based hospital programs. But despite the hurdles, others are moving full-speed ahead with new programs or expansions.

CMS began letting health systems provide hospital-level care to patients where they live in March 2020 to free up beds during the COVID-19 pandemic. Under the Acute Hospital Care at Home waiver, Medicare reimburses hospitals at the same rate for home-based acute care as it does for care in a facility. The waiver expires at the end of December and Congress must decide to extend or end it.

The agency has approved 366 waivers across 138 health systems as of Oct. 10, according to a CMS spokesperson. While a CMS report released last month gave hospital-at-home a mostly positive review, health systems may not be actively enrolling patients or have suspended their programs for a variety of reasons.

Some health systems that received CMS waivers never even got their hospital-at-home programs off the ground.

University of California San Francisco Health scrapped plans to launch a program in May 2023 because the California Department of Health Care Services stopped licensing at-home acute care programs when the federal public health emergency expired, said Dr. Timothy Judson, the health system’s medical director of care delivery transformation.

Judson said in an email he still hopes to launch hospital-at-home because the health system doesn’t have enough beds.

“If the CMS waiver is extended, I certainly do hope that California will create a pathway for [hospital-at-home],” Judson said.

Greensboro, North Carolina-based Cone Health got a waiver from CMS in July 2022 to launch a program at Moses H. Cone Memorial Hospital in Greensboro, but is still in a planning phase, said a hospital spokesperson, who would not provide additional details on when or if Cone Health might launch a program.

Other health systems have backed away from plans to scale their hospital-at-home programs due to regulatory uncertainty.

For example, Franciscan Health in Crown Point, Indiana, launched its hospital-at-home program in 2021. An expansion is on hold until the system has more clarity on the federal waiver, as well as state licensing and accreditation requirements, according to a spokesperson.

Some health systems that launched programs when the COVID-19 pandemic created a huge influx of patients are finding it difficult to expand them as patient demand for care has returned to pre-pandemic levels.

That’s been a problem for St. Bernards Medical Center in rural Jonesboro, Arkansas. The health system launched its AcuteHealth at Home program in March 2021 with plans for it to grow, said a hospital spokesperson. While the program continues, St. Bernards paused an expansion because it can’t find enough eligible patients who live within 30 minutes of the hospital, as required under the federal waiver.

The costs of launching and scaling acute care-at-home programs can also be a challenge, given the financial resources required for the technology, staffing and ancillary services necessary to support home hospital programs.

Tufts Medicine paused its hospital-at-home pilot at Lowell General Hospital in Lowell, Massachusetts, last year due to financial constraints, a spokesperson said. The health system “remained confident in the benefits of the program,” but decided to focus its resources on a mobile integrated health program and a program directed at patients with complex health needs. The spokesperson said those programs are better at decreasing avoidable hospital admissions.

Executing hospital-at-home is difficult for some health systems, said Pippa Shulman, chief medical and strategy officer of Medically Home. The Boston-based company partners with health systems to provide the technology platform and some staffing for home-based hospital programs.

She said some health systems are able to provide 24/7 care at a small scale when they launch hospital-at-home programs, but struggle to provide services as they expand.

“You need to be able to [to provide care] for five patients, for 10 patients, and for 50 patients from when you start,” Shulman said. “That is the moral imperative. You have to make sure you deliver safe and effective care. You want people to tread carefully before they do this. It’s a big step.”

Even some health systems with successful hospital-at-home programs have encountered hurdles.

The University of Arkansas for Medical Sciences launched an acute care-at-home program last year at the UAMS Medical Center in Little Rock, Arkansas, in partnership with Contessa Health, a division of home health company Amedisys. The medical center has cared for approximately 200 patients at home during the first year of the program, but staffing has sometimes been a challenge, UAMS Medical Center CEO Dr. Michelle Krause said in an email.

“We have physicians available for video conferencing with patients, but Contessa has had difficulties securing nurses to visit patients and deliver supplies,” Krause said.

In an email, a Contessa spokesperson said nurses are vital to home-based care, but admitted staffing can be difficult. “No hospital-at-home program is immune from this constraint. Having a reliable partner in the nurse staffing arena doesn’t remove the hurdle, but significantly mitigates the headwind,” the spokesperson said.

Despite the challenges, some health systems still view hospital-at-home as a safe, viable and economical alternative to facility-based acute care.

AdventHealth Orlando is weeks away from launching its first hospital-at-home program, a year after receiving a CMS waiver, according to a spokesperson.

Advocate Health is also bullish on the concept. It offers hospital-at-home to patients at 10 Atrium Health hospitals in North Carolina. Atrium launched its first program in 2020 and expanded hospital-at-home prior to its merger with Advocate Aurora Health, said Colleen Hole, AdvocateHealth innovation strategic advisor. Hole said the health system has treated approximately 13,000 patients across North Carolina so far and is eager to expand the program to other states.

“To continue to build beds, which costs between $2 million and $5 million dollars per bed, is not cost-effective,” Hole said. “This model has proven that it will deliver excellent care without the time and expense of building [brick-and-mortar facilities].”