Healthcare stakeholders call for hospital-at-home waiver permanency

March 13, 2024 - More than 65 healthcare organizations have signed a letter urging Congress to extend the Acute Hospital Care at Home waiver program for at least five years beyond 2024.

The letter sent to Congressional leaders on March 11 highlighted the critical role the waiver program played in enabling hospitals and health systems nationwide to implement the hospital-at-home model, stating that the waiver “is the keystone to the future of home-based care delivery for Medicare patients and beyond.”

The Centers for Medicare & Medicaid Services launched the Acute Hospital Care at Home (AHCaH) waiver in November 2020 to ease challenges facing hospitals amid the COVID-19 pandemic. The waiver enables hospitals to treat patients with inpatient-level care at home. If approved for the waiver, hospitals do not have to adhere to certain Medicare conditions of participation, including the requirement for on-site nursing services 24 hours a day, seven days a week.

Research published last year shows that patients receiving at-home hospital care under the waiver experienced a low mortality rate and minimal complications. The study conducted by CMS examined patient outcomes at the 277 hospitals with approved waivers as of March 20, 2023 — a total of 11,159 patients received care under the waiver.

The study revealed that 7.20 percent of patients were transferred from home to the hospital to complete their care. Only 38 unexpected deaths (0.34 percent) occurred in participating hospitals, with most occurring among COVID-19 patients that progressed to more severe illness symptoms.

The letter emphasized the clinical benefits linked to hospital-at-home care provided under the waiver. It further noted that the implementation of the waiver program resulted in a significant increase in hospital-at-home programs, from approximately 20 programs prior to waiver implementation to more than 300 hospitals across 37 states deploying these programs as of March 1.

“At this current trajectory, 1 in 6 hospitals will have HaH [hospital-at-home programs] by 2030,” the letter stated.

Thus, the organizations are calling for Congress to extend the waiver for five years beyond its current expiration date of December 31, 2024. An extension would allow hospitals and health systems to “continue building out the logistics, supply chain, and workforce for Hospital-at-Home (HaH) and to encourage multiple payers outside the Medicare program, including Medicaid programs, to enter the HaH market,” the letter noted.

Further, an extension would enable healthcare organizations to deploy home-based services equitably across populations and create needed inpatient capacity for the US healthcare system.

The letter’s signatories are prominent health systems, health technology companies, and trade associations, including the American Medical Association, Mass General Brigham, Intermountain Health, Best Buy Health, Biofourmis, Geisinger, the American Telemedicine Association, Mount Sinai Health System, and OSF OnCall.

Support for hospital-at-home care is growing across the healthcare industry.

On March 12, the American Hospital Association released a statement advocating for making permanent pandemic-era regulatory flexibilities surrounding telehealth and hospital-at-home care.

“Hospitals continue to see H@H [hospital-at-home] programs as a safe and innovative way to care for patients in the comfort of their homes,” the association stated. “A growing body of research shows that H@H is an effective strategy that improves all three components of the value equation — improve outcomes, enhance the patient experience and reduce cost.”

This growing body of research also includes studies conducted by healthcare provider organizations. In January, Mass General Brigham published a letter in the Annals of Internal Medicine detailing the positive clinical outcomes associated with the AHCaH waiver.

Researchers used 100 percent Medicare fee-for-service Part A claims for care delivered between July 1, 2022, and June 30, 2023, to identify all patients with an admission under the waiver. They examined data for 5,132 patients.

They found that the mortality rate for the patient population was 3.2 percent, the rate of skilled nursing facility use was 2.6 percent, and the readmission rate was 15.6 percent at 30 days post-discharge. In a stratified analysis of patients from underserved groups, researchers found that these outcomes were consistent across all groups.