The Centers for Medicare & Medicaid Services implemented the Acute Hospital Care at Home waiver during the pandemic with the goal of allowing patients to receive hospital-level acute care in their homes. The waiver, which is an expansion of the Hospital Without Walls initiative, is set to expire at the end of 2024. Still, some providers continue to grow their hospital-at-home efforts, finding benefits to patient outcomes, clinician experience and more.
One of these is Mass General Brigham (MGB), based in Boston, MA, a teaching affiliate of Harvard Medical School that began hospital-at-home operations in 2016. Dubbed Home Hospital in 2022, the program currently has the capacity to serve 33 patients at once, and expansions into three more MGB network hospitals aim to boost its potential patient capacity to 45. Heather O’Sullivan, president of Mass General Brigham Home Hospital, talked to McKnight’s Home Care Daily Pulse about the program’s successes, areas in which it is growing, and how it will adapt to an uncertain regulatory landscape.
McKnight’s Home Care Daily Pulse: You’re expanding Home Hospital offerings, yet the Acute Hospital Care at Home waiver, which helped to establish your program in 2022, is set to expire at the end of 2024. Are you concerned about this? How might it affect your program?
O’Sullivan: The regulatory environment is certainly evolving, and it’s uncertain, so that really necessitates a proactive approach to planning for the future landscape across federal, state and local levels. We have been and will continue to refine the foundational at-home capabilities to meet the future healthcare ecosystem needs. We have reasonable contingency and mitigation plans for alternative reimbursement models to advance our commitment to acute care home as a long-term strategy.
McKnight’s Home Care Daily Pulse: What is your motivation behind expanding this hospital-at-home program? Would you say it’s to increase your system capacity, or are there other aspects?
O’Sullivan: Many other aspects. Home Hospital is an imperative approach to increasing access to care by meeting the in-facility demand of our most critically ill patients. It also avoids unnecessary capital expenses and it delights our committed clinical workforce by offering an alternative setting of care. Overall, it achieves our top priority of meeting the expectation of patients and their supports in a manner that recognizes what’s most important to them during a vulnerable health event. And we do this by welcoming the opportunity to be guests in the privacy of our patients’ homes and understanding our communities.
McKnight’s Home Care Daily Pulse: What are the areas in which you are seeing the biggest successes within the Home Hospital program?
O’Sullivan: The most important measure of success is our patients’ experience and outcomes. National delivery of Home Hospital has delivered on both. We actively monitor satisfaction and outcomes, and we consistently see both outperforming patients’ experiences in inpatient facilities. We’ve even researched it; we have studies from 2021 that show that patients receiving inpatient level of care in the home setting had a better experience with their care team and reported better sleep. MGB’s Home Hospital service line also demonstrated improved quality outcomes, including lower mortality rates or episodes of care. And our research with the home hospital approach demonstrated that it reduces healthcare costs and readmissions, while favorably increasing the patient’s physical activity.
McKnight’s Home Care Daily Pulse: How unique are the services provided through Mass General Brigham’s Home Hospital program, and how are you seeing patients respond?
O’Sullivan: MGB Home Hospital meets all the requirements of participation for the Acute Care at Home waiver, and those include pharmacy, medication and hydration, infusions, respiratory care (including oxygen delivery), diagnostics, laboratory and radiology services. And then very specifically, monitoring. We have remote patient monitoring with at least two sets of patient vital signs daily, and we have much more. We also provide transportation, food services, durable medical equipment, PT, speech therapy, social work and expert care coordination.
McKnight’s Home Care Daily Pulse: How have workforce challenges affected the success of the program?
O’Sullivan: The entire healthcare industry is facing a daunting workforce challenge, yet what we have experienced is the Home Hospital actually helps us retain our clinical workforce that may otherwise burn out in the facility-based setting alone. Home Hospital allows our clinical workforce to engage and care for their patients in their own home, which both patients and providers really enjoy. Additionally, we have a team of “command center” clinical staff, providing remote coverage, which provides an increased level of flexibility and variety.
McKnight’s Home Care Daily Pulse: You touched a bit on how the program is growing and the different avenues through which you’re seeing growth. To what extent does hospital at home affect — or even perhaps hurt — your traditional brick-and-mortar business?
O’Sullivan: For health systems like MGB that are faced with growing patient demand, Home Hospital is purely a benefit to everyone — patients, providers and the business. Home Hospital is a more appropriate and less disruptive option for lower-acuity patients who can have their entire stay in the Home Hospital, and it provides a more rapid pathway back to home for sicker patients who do initially need that higher-acuity capability in the hospital, yet maybe only for a portion of their stay. So home hospital is simply a powerful new tool in the care setting toolbox that MGB is advancing.
McKnight’s Home Care Daily Pulse: Can you tell me a little bit about navigating reimbursement? What payers do you work with? Is it mostly traditional Medicare, Medicare Advantage, or other payers?
O’Sullivan: We’re engaging with all of our payers. Many have already agreed to reimburse for Home Hospital. Medicare has been reimbursing for home hospitals since November of 2020 under the special waiver, and MGB was one of a handful of systems nationally that were grandfathered in under the initial waiver due to our strong results and longstanding efforts operating this model of care. And since then, many state Medicaid programs including here in Massachusetts understand the importance of reimbursing a home hospital episode and almost all of our major commercial payers are also recognizing the tremendous political and fiscal benefits of this offering.
McKnight’s Home Care Daily Pulse: In what ways would you like to see your hospital-at-home program grow, and what might be getting in the way of that?
O’Sullivan: A lack of understanding is getting in the way. Many people inaccurately conflate a home health episode of care with a Home Hospital event. They’re simply not the same thing. They’re both critically important and valuable offerings; we would never treat an acutely ill patient in the traditional recuperative Home Health model. Rather, our Home Hospital patients require greater clinical interventions, which meet national standardized medical criteria and qualify an individual for a traditional brick-and-mortar hospital episode of care.
While we comprehend the magnitude of logistic variability, really honing in on the clinical expertise of a mobile workforce is ultimately what’s going to yield the broad adoption of this emerging site of care. It’s gonna take time. We are super excited and making amazing progress but we have a long way to go for sure.
Editor’s note: Peer-to-Peer is a feature from McKnight’s Home Care Daily Pulse in which we talk to the leaders in home care, your peers, about their operational initiatives, efforts and ideas. If you think someone in home care would make a good subject for Peer-to-Peer, please email Liza Berger at [email protected].
