‘Time To Claim The Future’: The Hospital-At-Home Model’s Chance To Decentralize US Health Care

Home Health Care News | By Andrew Donlan

Hospital-at-home care has a chance to become a mainstay in the larger home-based care ecosystem. As its stakeholders aim to get it there, there are a few factors that need to be considered. 
 
Firstly, without payment, there is no hospital-at-home model. Early pioneers of the model in the U.S. know that all too well. 
 
But Medicare providing adequate payment for hospital-at-home care during the public health emergency (PHE) was a major first step to get other payers to follow. The Centers for Medicare & Medicaid Services’ (CMS) Acute Hospital Care at Home waiver has already been extended through 2024 – it was initially supposed to expire at the end of the PHE – and now is up for another extension. 
 
Earlier this month, Sens. Tom Carper (D-Del.) and Tim Scott (R-S.C.) introduced a bill that would push back the expiration date of the waiver program by five years. An extension bill was also introduced in the House. 
 
That would make for an obvious tailwind for hospital-at-home stakeholders. It not only would keep the payment valve open for current hospital-at-home programs, but also give health systems interested in the model the assurance that investment will be worth their time. 
 
Additionally, earlier this year, Sens. Marco Rubio (R-Fla.) and Tom Carper (D-Del.) introduced the At Home Observation and Medical Evaluation (HOME) Services Act, which would allow providers to admit patients into hospital at home prior to being admitted in the brick-and-mortar hospital. 
 
The Acute Hospital Care at Home waiver taking on a wider scope, more payers following Medicare’s lead and more home-based care providers becoming involved isn’t just good news for the hospital-at-home model, though. 
 
It pushes forward the idea that the home can eventually be the epicenter of health care in the U.S., which is an idea that many home-based care stakeholders are behind, but also a major departure from the current system. 
 
“One may ask why a five year extension, as opposed to something made permanent,” Medically Home CEO Rami Karjian recently told me. “We think Medicare wants to go the bundled route for making this permanent. We think they have this vision, like with BPCI-A, acute and post-acute care integrated and paid for together. That’s where we think this is 
ultimately going to go.” …

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