Two large hospital systems and several home-based care companies are partnering to lobby Congress to make permanent COVID-19 era changes to CMS home healthcare reimbursement.
Intermountain Healthcare and Ascension are forming the Moving Health Home Coalition with several home-based care companies including hospital-at-home provider DispatchHealth, home-based complex care provider Signify Health, home health provider Elara Caring, value-based complex care provider Landmark Health and senior home care service provider Home Instead. The coalition has five big policy priorities that it will lobby Congress and other policymakers to open up home-based care reimbursement after the pandemic has ended.
The coalition also includes Amazon Care, which is similar to Doctor on Demand but includes house calls, and contracts with primary care provider Care Medical as an employee benefit. Care Medical in February filed to expand operations into 17 states.
One of the biggest policy requests is to allow hospitals to continue hospital-at-home programs. Intermountain Health was already working on a hospital-at-home program when CMS launched a policy by the same name that allows hospitals to transfer patients to ambulatory surgery centers, inpatient rehabilitation hospitals, hotels and dormitories, while still receiving hospital payments from Medicare. That policy was expanded in November when CMS launched the Acute Hospital Care at Home program, which allows hospitals to provide care at home for Medicare beneficiaries who would otherwise require hospitalization for conditions like congestive heart failure or pneumonia.
In Intermountain's program, 90% of Medicare partcipants prefered the hospital-at-home program to traditional hospital care according to Karey Palakanis, executive director of home-based services program Care Connect at Intermountain.
"Hospital-at-home has been an emerging market over the last few years, (but was) predominantly hampered by regulatory and financial restrictions to taking care out of the hospital-based environment and bringing it home," Palakanis said. "But this allowed us to take patients that we maintain in a hospital environment — at a much more significant cost — and allow them to have the comfort of home with the same level of services, leveraging technology like telehealth, remote patient monitoring, home health care."
The changes have allowed Intermountain and many other systems to expand home-based programs. Preliminary data from patients who have opted to receive hospital services at home show the same, if not better, outcomes, because they're able to address home environment aspects like the risk-of-fall directly, Palakanis said.
The coalition also wants to push for Medicare to cover high-acuity home-based services when it's an evidence-based practice used in a private sector model. That could include EMTs providing triage services in the home and offering a telehealth visit, instead of taking a patient to the emergency department, when clinically appropriate.
"Under current law you have to take the patient to a hospital for the ambulance service to be covered; but you don't necessarily need to take someone to an ER always," said Krista Drobac, executive director of the coalition, adding that a CMS waiver a few years ago allowed just that. "We need to explore the evidence around what that waiver did, and if patients able to get the care they needed at home."
The Moving Health Home Coalition also will advocate for CMS to create an extended home care bundled model that would serve as an alternative to skilled nursing facility stays.
"We do know that home-based care and in comparison to nursing home based care, are about 25% more likely to avoid readmissions within 30 days of discharge from a hospital, and we reduce mortality," Palakanis at Intermountain said. "Nobody wants to be moved back and forth, and the costs associated with that are substantial."
The coalition wants home-based evaluation and monitoring services be reimbursed at the same rate as the 2022 Medicare Physician Fee Schedule for what primary care office visits are paid. They're pushing to eliminate the budget neutrality requirement, which would require any increases to come at the cost of cuts to other providers. And the providers want home-based care providers to meet Medicare Advantage and commercial network adequacy standards.
Anne Tumlinson, CEO and founder of long-term care consulting firm ATI Advisory, said the home-based care companies involved represent some big players in the industry, and represent various components of the value chain.
"The big question is whether they can execute on moving the policy agenda forward and make in-roads in local healthcare delivery systems and persuade payers," Tumlinson said. "I'm sure that's a big part of the value to them of coming together — to influence change."