Recent research by Mass General Brigham highlights the transformative potential of hospital-at-home programs under the CMS Acute Hospital Care at Home waiver. The study, based on Medicare data from over 5,000 patients, underscores the positive outcomes, including low mortality rates and reduced readmissions one-month post-discharge. Strikingly, outcomes remain consistent across diverse demographics, offering hope for bridging healthcare disparities. The findings align with CMS research, emphasizing the viability of home-based care. However, challenges lie ahead as the waiver faces expiration in 2024. Policymakers and clinicians must weigh the evidence to determine the future of this groundbreaking approach to healthcare delivery.
Mass General Brigham’s recent exploration into hospital-at-home care provides a compelling narrative of a paradigm shift in healthcare delivery. With the CMS Acute Hospital Care at Home waiver as a catalyst, this research delves into the clinical outcomes of over 5,000 Medicare patients, offering a glimpse into the potential of in-home, hospital-level care. By lifting traditional constraints, this initiative challenges the conventional notion of hospitals as the primary locus of acute medical care. As the global movement toward home-based care gains momentum, this study aims to inform key stakeholders of the substantial benefits and implications of extending or permanently approving this innovative waiver.
CMS Acute Hospital Care at Home Waiver:
Launched in November 2020, the CMS Acute Hospital Care at Home waiver marked a pivotal shift in healthcare delivery by allowing approved hospitals to provide inpatient-level care in the homes of Medicare patients. The waiver lifted certain Medicare Hospital Conditions of Participation, enabling flexibility in service delivery. As of December 14, 2023, 308 hospitals across 37 states had obtained approval for this waiver.
Research Methodology and Patient Demographics:
To assess the impact of hospital-at-home care, researchers utilized 100 percent Medicare fee-for-service Part A claims data for care delivered between July 1, 2022, and June 30, 2023. The study focused on 5,132 patients who received hospital-at-home care under the waiver. The patient population was predominantly White (85.2 percent), with 41.7 percent aged 80 years or older. Notably, 13.8 percent were dual-eligible, and 1.7 percent resided in rural areas. Medically complex conditions were prevalent, with 42.5 percent having heart failure, 43.3 percent with chronic obstructive pulmonary disease, 22.1 percent with cancer, and 16.1 percent with dementia.
Clinical Outcomes:
The study revealed promising outcomes associated with hospital-at-home care. The mean length of stay was 6.3 days, and during hospitalization, the escalation rate was 6.2 percent, with a mortality rate of 0.5 percent. At 30 days post-discharge, the mortality rate slightly increased to 3.2 percent, while skilled nursing facility use and readmission rates were 2.6 percent and 15.6 percent, respectively.
Equity in Outcomes:
In a stratified analysis of underserved groups, including Black and Latino patients, dual-eligible individuals, and those with disabilities, researchers found consistent outcomes across all demographics. This suggests that hospital-at-home care can effectively reach and benefit a diverse range of patients, addressing concerns related to disparities seen in traditional hospitalizations.
Limitations and Conclusions:
The researchers acknowledged limitations, emphasizing that the results are specific to the Acute Hospital Care at Home initiative within traditional Medicare. Despite these constraints, they concluded that the study’s findings support the notion that the initiative is a vital care model for managing acute illnesses, especially among socially vulnerable and medically complex patients.
Alignment with CMS Research:
The recent study aligns with CMS research conducted in November, which examined patient outcomes at the 277 hospitals with approved waivers as of March 20, 2023. Results indicated a low mortality rate and minimal complications leading to hospital admissions for patients under the Acute Hospital Care at Home waiver. Notably, only 7.20 percent of patients were transferred to the hospital, and unexpected deaths were minimal, with 0.34 percent occurring, primarily among COVID-19 patients with severe symptoms.
Challenges and the Future:
Despite mounting evidence supporting the efficacy of the waiver, it is imperative to note that it is not a permanent solution and is set to expire at the end of 2024. Dr. David Michael Levine, the corresponding author, emphasized the need for data-driven decisions, stating that the analysis aimed to provide policymakers and clinicians with substantial information to determine the potential extension or permanent approval of the waiver, thereby expanding opportunities for patients to receive care in the comfort of their homes.
Overall, the Mass General Brigham study adds a crucial chapter to the evolving narrative of hospital-at-home care. Its affirmative findings not only support the effectiveness of the CMS Acute Hospital Care at Home waiver but also emphasize its capacity to transcend demographic disparities in healthcare outcomes. The alignment with CMS research reinforces the promising trajectory of this transformative approach. However, the imminent expiration of the waiver in 2024 presents a pivotal juncture. As stakeholders deliberate its future, data-driven decisions are imperative. The study’s role in providing comprehensive insights underscores the need for thoughtful consideration of hospital-at-home care as a permanent fixture in the evolving landscape of patient-centered healthcare.
