Sanford Health, one of the nation’s largest health systems in rural America, could advance the hospital-at-home movement when it launches its first acute home care program in North Dakota next spring.
The Centers for Medicare and Medicaid Services granted the Sioux Falls, South Dakota-based health system an Acute Care at Home waiver three weeks ago to launch the model from Sanford Medical Center in Fargo, North Dakota. The hospital will begin offering home-based hospital care to patients within a 25-mile radius of Fargo as early as March, said Susan Jarvis, the health system's vice president of operations for Fargo. The program will be the first of its kind in the state.
Sanford’s entrance into hospital-at-home could provide a boost to the model in rural communities where it has been slow to take off, due in part to a shortage of nurses and because most state Medicaid programs don’t reimburse for hospital-level care at home.
Jarvis said the hospital plans to scale the model at a later date to rural patients living up to 100 miles away using nurses and emergency medical technicians from some of its smaller critical access hospitals throughout North Dakota and northwest Minnesota.
“I think the way we are structured and the resources we have makes us uniquely positioned to do this in rural areas,” Jarvis said.
Hospital-at-home lets patients receive acute-level care at home through telehealth and in-person visits that are supplemented with remote-patient monitoring. The model gained steam during the COVID-19 pandemic when CMS launched the Acute Care at Home waiver program in an effort to alleviate hospital overcrowding. The waiver, set to expire at the end of next year, allows hospitals to deliver care to patients in their homes at the same reimbursement rate as in-facility care.
More than 300 hospitals in 37 states offer hospital-at-home care.
A study published in JAMA Health in November found more than 11,000 patients admitted to hospital-at-home programs during a 16-month period experienced low mortality rates and minimal complications. Still, some safety groups and labor unions have questioned the operational efficiency.
The model could fill a void in rural America, which has lost approximately 140 hospitals over the past decade. Equitable access to home-based acute care for both rural and urban patients could also increase the likelihood of Congress extending the waiver or making it permanent, said Nels Paulson, a University of Wisconsin-Stout sociology professor researching hospital-at-home.
“In terms of equity, rural is incredibly important for hospital-at-home’s future, but it has proven to not be an easy nut to crack,” Paulson said.
Sanford and other providers are trying to change the calculus for the model in rural communities. In August, Community Hospital Corporation, which owns and provides consulting services to community hospitals, partnered with Resilient Healthcare to offer in-home services to community hospitals across 40 states. Some of those facilities serve rural communities. The joint-venture is expected to launch its first hospital-at-home program early next year, a Resilient Healthcare spokesperson said.
Researchers at nonprofit Ariadne Labs, a joint venture between Boston’s Brigham and Women’s Hospital and Harvard University’s T. H. Chan School of Public Health, will begin releasing results next spring of a three-year trial of rural home hospital-at-home programs at the Appalachian Regional Healthcare serving Kentucky and West Virginia and Blessing Health System in Quincy, Illinois.
The research launched in 2020 is studying whether the model in rural settings can offer high-quality care at a lower cost. Although both hospitals have experienced staffing challenges, program leader Dr. David Levine said early data on patient acceptance and hospital execution is encouraging.
“It’s a much more agile model that can be expanded and retracted as needed,” Levine said. “We think it could be an amazingly impactful way for lots of communities to maintain their acute care functions, but deliver them in a right-sized way."