The Acute Hospital Care at Home waiver, implemented by CMS in 2020 due to the COVID-19 pandemic, has allowed hospitals and health systems to provide hospital-level care to patients in their own homes. This waiver has proven to be highly beneficial, with over 300 hospitals in 37 states taking advantage of this payment waiver. However, without further congressional action, this waiver is set to expire at the end of 2024. It is crucial to extend this waiver to continue expanding access to innovative hospital-at-home care.
Research has shown that hospital-at-home programs have numerous benefits for patients, their families, and healthcare providers. Studies have revealed low rates of emergency returns to the hospital, referrals to skilled nursing facilities, 30-day hospital readmissions, and mortality among patients who received hospital care at home. Additionally, patients with disabilities or dementia, as well as those dually eligible for Medicare and Medicaid, have demonstrated similar or better outcomes compared to the general hospitalized population. Hospital-at-home programs align with the principles of the Age-Friendly Health Systems movement, which focuses on delivering evidence-based care that reduces harm and meets the needs of patients and their caregivers.
Hospital-at-home programs have garnered support from various stakeholders, including major health professional organizations such as the American Medical Association and the American Hospital Association. Clinicians have reported positive experiences working in these programs, and patients have expressed a preference for receiving care in the comfort of their homes. Family caregivers of hospital-at-home patients have also reported lower levels of stress compared to those with loved ones in traditional hospital settings. The support for hospital-at-home programs emphasizes the importance of extending the waiver to ensure continued access to this innovative care model.
Despite the success of hospital-at-home programs, challenges remain in terms of access and equity. Currently, only a limited number of state Medicaid programs cover hospital-at-home care, creating barriers to equitable access for low-income residents. Health systems are working to extend these programs to rural and underserved areas, but more efforts are needed to ensure that all patients who could benefit from hospital-at-home care have access to these services. A recent report from the Bipartisan Policy Center recommended a 5-year extension for the Acute Hospital Care at Home waiver, highlighting the need for further research and technical assistance to improve care quality, safety, and cost savings.
Extending the Acute Hospital Care at Home waiver is essential to expanding access to hospital-at-home programs and ensuring that more patients can receive care in the comfort of their own homes. This innovative care model has demonstrated positive outcomes and has the potential to transform the way healthcare is delivered, particularly for older adults. By addressing issues of access and equity and providing additional support for the implementation of hospital-at-home programs, we can continue to improve care quality and patient experience across the healthcare system.
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