Planning Medical expenses

Future support for the hospital-at-home program waiver will require data to prove its value, but the fragmented nature of the program might make this tough to demonstrate, according to the Medicare Payment Advisory Commission (MedPAC) in a meeting earlier this month.

“Hospital-at-home is a new care model, and it is still being defined,” said Evan Christman, a senior analyst at MedPAC, according to a transcript of the meeting.

Home hospital programs nationwide are far from homogenous, he noted. Many vary widely in their design, services provided and patient characteristics, making it difficult to quantify their cost or their patients’ outcomes. 

In 2020, the Centers for Medicare & Medicaid Services created the temporary Acute Care Hospital at Home Program under the Consolidated Appropriations Act, allowing hospitals to apply for a waiver to deliver acute care within a patient’s home. Congress extended the waiver to the end of 2024, but future legislative action will be required to extend it any further.

In the fall of 2024, the Department of Health and Human Services will need to submit an evaluation of the hospital-at-home waiver’s utilization trends, care quality and costs, but “conducting this analysis will be challenging,” according to Christman.

The hospital-at-home waiver is still a relatively small program operated on a voluntary basis. Only 285 hospitals have been approved to operate under the waiver, but only 101 have reported any volume, Christman said. 

Meanwhile, current administrative data fails to identify all of the services and costs incurred by program participants, while analyses of different hospital-at-home providers yield varying results, he noted. Patients in these programs generally may exhibit the same mortality rate as hospital patients, but stay lengths and readmission rates varied. Also, evidence that hospital-at-home reduces care costs was “limited,” Christman said, though some findings did suggest lower spending.

“The results for most studies indicate that beneficiaries can be safely served in the home, but questions remain about outcomes and cost,” Christman noted. “A critical issue is that patients are selected for the program using detailed clinical and social data that is not captured in Medicare’s claims.”

In order for hospital-at-home providers to ensure continued support for the waiver program, MedPAC made a number of recommendations. Key quality measures for acute in-home care should be developed, the commission said. Also, more accurate tracking of service utilization and costs can prove the benefit of home hospital programs, especially when compared to in-clinic acute care.

“Hospital-at-home is a new and evolving care model,” Christman said. Data collection and analysis will be key to its continued success, he noted, but clearer standards for the program may also be in order. Christman asked: “Does Medicare need to take steps to better define the care model?”

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