Patients who participated in a hospital-at-home model crafted by the Icahn School of Medicine at Mount Sinai reported shorter readmissions, fewer emergency department visits and better patient experience than those with traditional hospital stays, according to a new study.
The findings, published Monday in JAMA Internal Medicine, come as the CMS considers adding an iteration of the model to the Medicare program. In a letter on June 13, HHS Secretary Alex Azar directed the CMS to work with Mount Sinai and other stakeholders to amend the model for possible implementation in Medicare.
Mount Sinai tested the model from 2014 to 2017 as part of a demonstration under the Center for Medicare and Medicaid Innovation.
"We always expected the model would be tweaked because it would be implemented nationally," said Dr. Albert Siu, an author of the study and chair emeritus of the Brookdale geriatrics and palliative medicine department at the Icahn School of Medicine. "We look forward to working with the CMS in making this available to Medicare beneficiaries."
Under the model, eligible patients are transferred from the hospital to their home, where they continue to receive acute-care services from Mount Sinai physicians, nurse practitioners and nurses. When the patient's illness has resolved, the patient is discharged from hospital-at-home care but they continue to receive support services for a 30-day period. Called the post-acute period, the patient has access to nurses and social workers who manage and coordinate care as needed.
This 30-day post-acute period is unique. No other hospital-at-home model includes a post-acute period, Siu said.
If CMS approves the model, it would likely be an advanced alternative payment model under MACRA, he said.
Mount Sinai analyzed the clinical data from the model and found it led to improved patient outcomes. Specifically, hospital-at-home patients had a 8.6% 30-day readmission rate, which was lower than the 15.6% readmission rate for the control group of acute-care hospital patients. Additionally, hospital-at-home patients had an 5.8% 30-day emergency department revisit rate versus an 11.7% ED revisit rate among the control group. Hospital-at-home patients were also more likely to report the highest overall rating for overall hospital care in the HCHAPS survey than the control group.
There were 19 patient conditions eligible for the hospital-at-home model. The four most-frequent conditions under the model were urinary tract infections, community-acquired pneumonia, cellulitis and congestive heart failure.
The study included 295 hospital-at-home care patients and 212 control patients.