The hospital-at-home program at UMass Memorial Medical Center in Worcester, Massachusetts is thriving. But it could be running out of time.
Justin T. Precourt, chief nursing officer at UMass Memorial, said the hospital is treating 15 patients per day through the program, which is in its second year. The health system relies on a care at home platform from Current Health, a Boston-based digital health startup, to treat acute-care patients within their home. It also uses telehealth to connect patients virtually.
The feedback to the program has been remarkable, Precourt said, particularly from patients and providers. Importantly, it has helped the hospital deal with the physical constraints it faces with limited beds, he said.
“Because of capacity constraints, we end up having patients waiting in our emergency departments and in ambulatory clinics. They’re not receiving the timely care that they need,” Precourt said. “The hospital-at-home program gives us an opportunity to provide a low-cost, high-level of care to patients in their home and expand our overall capacity.”
But that could all go away when the public health emergency ends. The program has been buoyed by a November 2020 waiver from the Centers for Medicare and Medicaid Services that pays hospital diagnosis-related group payment for hospital-at-home patients. The waiver is in place for the duration of the PHE. When the PHE ends, hospital-at-home will have a 60-day grace period and then the waivers will expire.
Precourt said he is nervous about the ticking clock.
“We're not in a situation where we could continue down the same route without the waivers and without the reimbursement,” Precourt said. “So, we are looking at alternative models, which would be a bit different from what we've been doing.”
An uncertain future
Like UMass Memorial, most of the other 244 other hospitals across 36 states involved with the program face the same reality. Their hospital-at-home programs have been worthy investments because of CMS’ flexibilities around payment. But as Precourt said, most health systems are operating “razor-thin margins,” and some are deeply in the red. The only way to support a hospital-at-home program long-term is reimbursement from government and private payers, he said.
While some private payers do negotiate hospital-at-home care, reimbursement has been varied. For CMS to make the program permanent would require legislation. The only proposal that has come up that would fully continue the program, Hospital Inpatient Services Modernization Act, went nowhere.
The Advancing Telehealth Beyond COVID-19 Act of 2022, which passed the House 416-12, would extend one component of home-based care. There is still a lot to sort out, said Blair Cantfil, partner with Manatt Health, a Los Angeles-based law firm.
“There is widespread agreement that allowing hospital-at-home is the best thing from a patient perspective,” Cantfil said. “The sticking point, as it relates to passing legislation, is figuring out whether continuing these flexibilities will increase costs to the Medicare program or create program integrity concerns.”
In theory, Cantfil said allowing patients to receive appropriate care in the home can simply replace the care provided in the hospital, except in cases where the availability of home-based services increases access to people who would otherwise forgo needed care. She said it’s up to Congress to continue the program flexibilities beyond the PHE.