Virtual hospital-at-home could offer alternative to CMS waiver

Modern Healthcare – Wednesday, November 27, 2024
By Diane Eastabrook

At-home hospital care that is entirely virtual can be as safe and effective as in-facility care, according to researchers at a California medical center touting an alternative to traditional hospital-at-home.

Health systems are looking for more cost-effective ways to provide care to people at home as the nation’s more than 70 million Baby Boomers age and require more healthcare services. The Centers for Medicare and Medicaid Services Acute Hospital Care at Home waiver program has been one way to accomplish that and approximately 140 health systems across 39 states have gotten federal approval to offer acute care at home. But the program has proven to be difficult for some health systems to execute and the waiver could expire at the end of this year without Congressional action, so some systems and others are exploring alternatives.

Los Angeles General Medical Center researchers said Tuesday in a Jama Network Open study that the provider’s virtual acute care at-home program could be a way for health systems that are strapped for staff and unable to offer home-based hospital programs through CMS’ waiver, which requires health systems to provide both in-person and virtual care to patients where they live for the same Medicare rate as a hospital stay.

Here is what to know about hospital-at-home and Los Angeles General Medical Center’s Safer@Home program.

What challenges have health systems run into with CMS’ waiver program?

The Acute Hospital Care at Home waiver requires hospitals to send nurses to patients’ homes twice a day, provide daily virtual visits with a physician or nurse practitioner, monitor patients through wearable devices and provide other ancillary services patients would receive in the hospital.

Some health systems have had difficulty launching the CMS program because of staffing shortages. Others have delayed or scrapped plans to offer hospital-at-home due to the high cost of remote patient monitoring technology and the virtual command center that supervises care.

In California, the state health department stopped licensing health systems to participate in CMS’ waiver program when the COVID-19 federal public health emergency expired last year.

How does the virtual program at LA General work?

The Safer@Home program discharges eligible patients to their homes, where they receive entirely virtual clinical visits, remote vital signs monitoring and oral or inhalation therapy, rather than intravenous therapy.

Patients enrolled in the program receive treatment for 10 qualifying conditions, such as cellulitis, bacterial pneumonia, COVID-19 and heart failure. The conditions covered by the Safe@Home program are among the same conditions covered by traditional hospital-at-home programs.

Nurses and hospital-based physicians provide virtual care for 12 hours a day, seven days a week. The team follows up with patients until they determine patients no longer need virtual care or their conditions escalate, requiring urgent care.

What were the results of the Safer@Home program?

Researchers found patients who received care at home were released from care four days sooner than their in-facility counterparts. They were also less likely to return to hospital emergency departments within 30-days of discharge and had no significant change in mortality compared with patients who received treatment in the hospital.

The study compared 876 patients who received care where they lived through Safer@Home with 1590 patients with matching diagnoses who received care in the hospital between Sept. 1, 2022 and Aug. 31, 2023.

The research team concluded that Safer@Home is a viable alternative to home-based hospital programs that require health systems to deploy staff to where patients live.

How do other home-based acute care programs work?

Some health systems and healthcare technology companies are developing other new ways to deliver care to acutely ill patients where they live.

Ochsner Health launched acute care at home in March at Ochsner Medical Center-New Orleans and hopes to roll the program out to its entire system after a successful pilot. The program, in partnership with technology company myLaurel, provides both virtual and in-home visits, along with lab work, medication and other services. The program prevented either initial hospitalizations or 15-day hospital readmissions for 92% of the patients referred to the program, the system said.

Denver-based DispatchHealth partners with health insurers to provide hospital-alternative care to patients at home through its Advanced Care program. The program provides in-home and virtual care to patients with a variety of conditions, including heart failure, cellulitis and pneumonia. Patients also receive lab work and other tests at home. DispatchHealth also partners with some health systems to deliver acute care at home through the CMS waiver.

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