Mayo Clinic and Kaiser Permanente formed a new coalition to push HHS and Congress to keep their hospital-at-home programs and investments going post-pandemic.
Hospitals across the country have spent big in moving acute care to patients' home as COVID-19 tested the safety and capacity of systems to keep caring for patients within their facilities. For instance, Mayo and Kaiser in May invested $100 million in Medically Home, which partners with systems to provide services like emergency care and cancer care. Many other members of the new coalition also use the company, like Adventist Health, ProMedica and UNC Health. Other systems have built their own programs.
Eventually, the national public health emergency that allowed CMS to create the Hospital Without Walls program will end, and reimbursement for these services will stop. This new sector has exploded thanks to the new payments, which were largely restricted to special populations previously.
The Advanced Care at Home Coalition will work on creating a blueprint for a new Center for Medicare and Medicaid Innovation model that would allow providers to apply for continued flexibilities in the longer term. But CMMI models usually take years to develop and implement, so they're also working on a bill that Congress could pass to extend Hospital Without Walls if there is a hard stop to the public health emergency.
"It would be a substantial disruption for providers," said Mara McDermott, the executive director at the new coalition. "All this infrastructure has been put in place. But there's also a very strong patient care component to the disruption that would really be a shame to have lost all this progress that we've made during the pandemic."
The health systems are also collecting information on how acute care at home programs have seen changes in Medicare costs, patient experience, quality outcomes and health equity.
That data will be critical as hospital-at-home programs question the logistics of delivering their care. While there is research showing that some of these programs did increase hospital inpatient capacity, it's not clear if quality outcomes maintained, or if the programs need new quality and safety metrics.
Anne Tumlinson, CEO and founder of long-term care consulting firm ATI Advisor, said it will be crucial to make sure there aren't racial or socioeconomic factors that affect whether patients can receive a hospital level of care at their homes.
"I think this points to the big challenge policymakers will face next year when the public health emergency ends: They are going to have to make some hard decisions about which new care modalities (like hospital at home or telehealth) to keep or toss," Tumlinson said. "The primary challenge will be in designing new permanent programs under financial incentives that emphasize value over volume."
Another coalition — called Moving Health Home — formed earlier this year, with Intermountain Healthcare and Ascension, along with several home-based care companies including hospital-at-home provider DispatchHealth and home-based complex care provider Signify Health, tackling a much broader agenda. The group wants a bigger move toward care in the home and is pushing for Medicare to pay for EMT services even when a patient isn't taken to the hospital and primary care and infusion services at home. The group also called for extending a bundled model that serves as an alternative to skilled nursing facility stays.
Tumlinson said it's crucial to have groups focusing on tackling answering questions of how programs have worked, but she cautioned that there should still be a focus by systems and policymakers on preventing hospitalizations and public health.
"There's no question we need to reduce the use of inpatient hospital care," Tumlinson said. "But is the solution to just switch the setting for this level of care or to prevent it in the first place?"