The hospital-at-home concept was developed long ago, but did not gain popularity until the COVID-19 crisis. And while its stalling was due to logistical and reimbursement problems, experts believe it’s finally here to stay.
For home health and home care providers, that means another area to deliver their expertise and increase their bottom lines.
As of April 16, 56 health systems and 127 hospitals across 29 states have been accepted as participants in the Centers for Medicare & Medicaid Services’ (CMS) hospital-at-home initiative, which is officially dubbed the “Acute Hospital Care at Home” program.
CMS also has received continued interest in involving new health systems and hospitals in the program, a CMS spokesperson told Home Health Care News.
Susan Maupin, the VP of health care operations at the consulting firm Advis, has seen her clients’ interests completely shift during the public health emergency as part of that trend. Chicago-based Advis consults a wide range of health care providers, including solo practitioners, home-based care agencies and larger health systems.
“This concept, I think, will have some longer-term strategy benefits for the health care system,” Maupin said. “And I think it’s a very useful tool for some of those patient populations to help keep them safer at home and free up those in-patient hospital beds as well.”
Maupin likewise sees the chance for home-based care agencies to capitalize on the trend, if they are able to find the right ways to contribute.
“I do think that there are opportunities, whether it’s a hospital-owned home health agency or third-party owned,” Maupin said. “There’s a place for everyone in the health care system. And if somebody is being cared for in the home at that hospital level, there can be good synergies between home-based care providers and health systems.”
After that hospital-level care at home, for example, it sets up the home-based care agency for a chance to care for patients afterward, when they no longer qualify for that higher-acuity care.
“They can ease that transition [for the patient], because they’re not going to qualify for that hospital-level care forever,” Maupin said. “But if they’re already in their home, whether they had home health prior to — or need it after — I think there would be good synergies between those hospital-at-home programs and home health care, where they’re not conflicting with one another, and instead working together on smoother transitions.”
Agencies need to set themselves up for these opportunities, however.
Asking the right questions
Before aiming for hospital-at-home partnerships, there are questions that each home health or home care provider should be asking themselves, Maupin said.
“You have to make sure that you have the equipment capabilities,” she said. “And do you have the staff? Each agency really needs to take a good look at what they have to offer. Are there any changes that you need to make to be able to step in that kind of role? Can you do assessments? Can you reach a patient within 24 hours and start that service right away?”
The SNF-at-home model, which home health agencies have explored as skilled nursing facilities (SNFs) have struggled during the pandemic, similarly requires retooling.
Before exploring either, certain competencies need to be met.
“I think all home health agencies need to evaluate their service offerings and make sure that they can provide that next-level care that a hospital at home patient may need,” Maupin said.
In regard to CMS, Maupin does believe that the model will continue to be reimbursed moving forward. If it does, there’s a lot to consider in order to make it financially worthwhile for both hospitals and the assisting home-based care agencies.
“I do think that there’s a lot of things that have to be taken into account when providing care in the home environment,” she said. “And if you’re going to reimburse at a hospital level, or something akin to that, there’s going to have to be a lot of things that take place to make sure that that the care is synonymous with that reimbursement structure. But I do believe it could happen.”
HaH growth factors
Of the factors driving hospital-level care into the home are the Acute Hospital Care at Home model’s success, a shortage of clinicians, COVID-19’s overall impact and patients’ growing desire to be at home.
That’s according to an analysis by San Antonio, Texas-based Frost & Sullivan, a business consulting firm involved in market research, analysis and growth strategy advising.
The largest barriers to the widespread adoption of hospital-at-home, though, are also stark and prevalent. Those include resistance from clinicians to engage in a brand new model in a different environment, implementation challenges, patient privacy and limited data interoperability.
“It’s sort of the difference between understanding you need to change, knowing how to change and making the change, because some things are just so hardwired into systems,” Dr. Bruce Leff, a researcher from Johns Hopkins who helped pioneer the model, previously told HHCN. “Rewiring health care, health care delivery and attitudes — all of that is hard.”
Relationships between home-based care agencies and health systems could go a long way to break through all of those restraints — and help hospitals break out of their traditional comfort zones.
“I think that keeping people in their home when it’s appropriate is just a positive movement for health care,” Maupin said. “[Agencies] have demonstrated good quality care and good outcomes at a lower cost. And the more we can keep the elderly population at home — in an environment where they’re safe — it’s a positive.”
On Frost & Sullivan’s end, it envisions a system in the future where brick-and-mortar hospitals are solely dealing with critical conditions, while dealing with other acute ailments almost exclusively in the home.
The advancement of technology will help expedite that trend.
“Advanced technologies will allow many more acute conditions to be covered under the hospital-at-home care model and improve patient experiences and outcomes,” the firm’s analysis read.