Congress should extend a waiver program allowing hospitals to provide acute care at home, but changes may be necessary to help ensure patient safety, according to a bipartisan think tank.
Although initial data regarding the hospital-at-home model is promising, more research is needed on expenses and outcomes before large-scale implementation, the Bipartisan Policy Center said in a report released Wednesday. Pushing back the waiver's Dec. 31 expiration date by five years could prompt wider hospital participation and encourage more states to cover the program under Medicaid, the center said.
Related: Mortality rates low among hospital-at-home patients: study
Under the waiver program, which the Centers for Medicare and Medicaid Services launched in 2020 at the height of the COVID-19 pandemic, Medicare reimburses hospitals at the same rate for in-home acute care as an in-facility stay. About a dozen state Medicaid agencies also pay for home-based hospital care.
More than 330 hospitals across 37 states offer hospital-at-home services through the waiver, including facilities affiliated with Mass General Brigham, Mayo Clinic and Cleveland Clinic.
Obstacles such as high startup costs and unknown financial impacts have prevented some hospitals from participating, the report said. Most state Medicaid programs also do not pay for the service. CMS should step in to help get initiatives off the ground, said Bipartisan Policy Center Health Director Lisa Harootunian.
“CMS needs to provide [hospitals] more technical assistance and guidance to start a program,” she said. “That could be in the form of a toolkit or educational resources.”
The center in its report called on Congress to direct CMS to gather and eventually submit evidence regarding patient outcomes, quality of care and overall costs for hospital-at-home programs, along with the demographic information of those treated through the model. Congress could use such data to decide whether to continue extending the waiver program, permanently implement it or sunset it, the report said.
It also recommended Congress direct CMS to strengthen regulatory guidance, such as on safety protocols related to fall prevention, infection control, telehealth and remote patient monitoring.
The list of recommendations is similar to those in a 2023 report by the Center for Economic and Policy Research, a left-leaning think tank. The CEPR report urged Congress and CMS to identify best practices for hospital-at-home programs and measure outcomes through rigorous research.
Moving Health Home, a trade group representing hospitals and hospital-at-home vendors, said the center's recommendations were reasonable and that standardized quality measures are appropriate and essential to scaling the care model.
While some studies have found home-based hospital care to be relatively safe and popular with patients, National Nurses United has raised concerns. The union, which represents approximately 225,000 registered nurses, in a 2022 report called the hospital-at-home model dangerous and said its care falls short of in-hospital services.
National Nurses United did not respond to requests for comment about the hospital-at-home model.
Correction: An earlier version of this article incorrectly said National Nurses United did not respond to requests for comment about the Bipartisan Policy Center report.
