Hospital-at-home patients were more likely to be white, had longer lengths of stay and cost Medicare less money than patients receiving in-facility care, according to a new report by the Centers for Medicare and Medicaid Services.
In the 79-page report released Monday, CMS evaluated home-based acute care delivered at 332 hospitals nationwide as a requirement of the Consolidated Appropriations Act of 2023. The report was mostly positive for the Acute Hospital Care at Home waiver program and could influence lawmakers as they decide whether to extend or end the waiver set to expire at the end of December.
Related: Mortality rates low among hospital-at-home patients: study
Hospital systems, including Mass General Brigham, Cleveland Clinic, Mayo Clinic and Kaiser Permanente have made big bets on hospital-at-home because it helps them treat more patients without adding beds. However, the program has been difficult to scale in rural areas.
Here are five things to know about the findings in the CMS hospital-at-home study:
1. Patients were mostly white, urban
The majority of patients participating in acute care at home programs were white and lived in urban areas, compared with patients receiving facility-based care. They were also less likely to be on Medicaid or receive other low-income subsidies. CMS attributed the demographic differences to guidelines hospitals developed to identify participating patients. They had to be willing and able to participate, clinically and psychosocially appropriate and live in homes deemed safe for care.
2. Few conditions were treated
Hospitals confined home-based acute care to patients with certain conditions. The most common illnesses treated involved respiratory, circulatory and renal conditions as well as infectious diseases. Some common illnesses included congestive heart failure, acute asthma exacerbation, urinary tract infections and pneumonia.The study did not collect information on why hospitals limited treatment at home to those conditions.
3. Mixed results on quality of care
Patients who received care at home under the waiver generally had lower mortality rates across the top 10 treatment conditions compared with patients receiving facility-based care. In comparing 30-day readmission rates, hospital-at-home patients treated for less complex respiratory and infectious illnesses fared better than those who received care for those conditions in a hospital. However, patients treated at home for more complex clinical conditions related to respiratory infections had higher hospital readmissions. There was little difference in readmission rates between patients treated at home and in a hospital for heart failure and shock.
4. Longer length of stay, lower costs
While hospital-at-home patients had a slightly longer length of stay than in-facility patients, their care resulted in lower Medicare costs for services in the 30 days following discharge. CMS said differences in patient selection criteria and clinical complexity for home hospital patients made it hard to determine if the Acute Hospital Care at Home waiver resulted in lower overall Medicare spending compared with patients getting facility-based care.
5. Positive patient satisfaction
Patients and their caregivers were generally satisfied with the care they received at home. CMS hosted a series of four virtual listening sessions with patients, caregivers and other stakeholders to get feedback on the waiver program. It also conducted site visits and corresponded directly with patients and hospitals to collect anecdotal information to compare beneficiary experiences with acute care at home.
Patients described feeling more comfortable and less anxious receiving care in their homes, according to the study. Caregivers said they felt less stressed when they could be in a familiar setting with family members. Still, some caregivers expressed concern about patient fatigue due to over-scheduling of appointments. Patients also had some confusion over the types of services that are provided through hospital-at-home programs.
