Nemours Children’s Health plans to launch a pediatric hospital-at-home program next year, despite questions about how it will be reimbursed for home-based care.
The program would provide acute home-based care to patients within a 40-mile radius of the health system’s two hospitals in Wilmington, Delaware, and Orlando, Florida, said Dr. Eric Jackson, chief innovation officer. The care would include remote patient monitoring, telehealth and in-person visits to children with urgent, short-term illnesses such as respiratory syncytial virus, Covid-19, bronchitis and influenza.
Related: Hospital-at-home providers push for Medicaid coverage
The program could help the nonprofit health system care for more patients when its hospitals are at capacity, Jackson said.
“Our intention is to launch in fiscal year 2024, but we have a lot to do to make that happen,” Jackson said. “One of the biggest challenges we have is we don’t have a clear-cut reimbursement strategy because a lot of pediatric hospitals are reimbursed through Medicaid.”
Nemours would be the first children's hospital to launch a hospital-at-home program and it could be a litmus test for other health systems looking for ways to provide more care to young patients outside of hospital walls. But the success of pediatric acute home care programs is contingent on getting state legislatures to back the model.
Most state Medicaid programs do not pay for beneficiaries to receive hospital-level care at home. Advocates of home-based acute care say wider Medicaid coverage of those services is imperative for the model to expand.
Hospital-at-home gained traction during the COVID-19 pandemic when the Centers for Medicare and Medicaid Services launched the Acute Care at Home waiver program as a way to ease hospital overcrowding. Under the waiver, set to expire at the end of next year, Medicare reimburses for in-home acute care at the same rate as in-facility care for adults.
Hospital-at-home reimbursement under Medicaid and Children’s Health Insurance Program could be a boon to the expansion of services. Nearly 7 million children and 83 million adults receive benefits under the programs, while about 66 million people are covered under Medicare, according to CMS. But while Medicare is administered by the federal government, Medicaid is administered by individual states that have different regulations.
Only seven states—Massachusetts, Oklahoma, Michigan, Oregon, Texas, South Dakota and North Dakota—allow Medicaid beneficiaries to receive home-based acute care. Arkansas’ Medicaid program reimbursed for hospital-at-home during the pandemic, but ended coverage last spring when the public health emergency expired.
Jackson said Nemours is lobbying for Medicaid and CHIP reimbursement of hospital-at-home in Delaware and Florida, and he expressed optimism those states will approve coverage in the next several months.
Still, Nemours is prepared to move ahead with its program without Medicaid coverage in place. Jackson said private health insurance, as well as efficiencies and cost-savings derived from home-based care, could offset some financial losses incurred from children covered under public insurance plans.
Other children's hospitals also see the potential of hospital-at-home. Columbus, Ohio-based Nationwide Children’s Hospital is exploring the possible launch of an acute care at home program, according to a spokesperson. Children's Hospital of Philadelphia is extending digital technology into the home, which could provide the foundation for a hospital-at-home program in the future, said a hospital spokesperson.
Pediatric hospital-at-home models have shown promise in Europe under national health insurance programs. A study of more than 800 children who participated in home-based care in Spain between 2018 and 2020 found that patients experienced low hospital admission rates and the care model proved cost-effective. A randomized control study of nearly 400 children in Great Britain in 2002 found that those treated at home had equivalent outcomes compared with those treated in hospitals.
