As regulatory uncertainty lingers around hospital at home, DispatchHealth leaders believe there is still plenty of momentum behind the model.
“I don’t know if I fully agree that things are on pause with hospital-at-home,” Kevin Riddleberger, co-founder and chief strategy officer for DispatchHealth, told Home Health Care News. “People are continuing to lean in on this. Even though only 5% to 8% of all hospitals across the country have the CMS waiver, I think you’re still seeing growth in it.”
During the public health emergency (PHE), the Centers for Medicare & Medicaid Services (CMS) created the Acute Hospital Care at Home waiver, which gave hospitals, health systems and other home-based care providers the ability to provide hospital-level care in the home. As of Sept. 30, 114 health systems and 256 hospitals in 37 states had been approved to provide care underneath the waiver.
The Acute Hospital Care at Home waiver is set to expire when the PHE does, which has some providers concerned.
However, Riddleberger is encouraged by more health systems applying for the waiver. He and stakeholders are coming together to help solidify some loose ends.
The Denver-based DispatchHealth is an in-home urgent care provider that has expanded its horizons since its founding in 2013. The company currently services 51 markets across the U.S.
Educating members of Congress and other policymakers on the value of hospital at home is a top priority for players in the space as DispatchHealth leans further into the model, Riddleberger said.
“Once the PHE goes away, there’s no payment mechanism for Medicare beneficiaries or provider organizations to take care of these patients or be reimbursed for taking care of these patients,” Riddleberger said. “These are patients that ultimately would be in a traditional brick-and-mortar setting that could be safely treated, at the same acuity level, in the comfort of their home.”
While plenty of hospitals have been approved to provide hospital-level care in the home under the CMS waiver, Riddleberger said some clarity would be welcomed as to what the future of the waiver program will look like.
“Health systems and provider groups want to be able to see a path forward,” he said. “We need to have a little bit more clarity as to what reimbursement will look like. That goes for groups like ours as well as health system organizations.”
The “Hospital Inpatient Services Modernization Act,” which would extend the hospital-at-home waiver by two years past the expiration of the PHE, has been introduced. But nothing has come of it yet.
Hospital-at-home stakeholders would like to see that passed, as well as a more permanent reimbursement structure for the model moving forward, Riddleberger said.
Leveraging technology, data
DispatchHealth has invested heavily in the ability to orchestrate care safely inside the home.
But there are still advantages to a hospital setting, like having everyone under one roof, Riddleberger said.
In order to mirror that type of care, tech-enablement has to be up to par.
“When we’re dealing with an individual inside their home, you need to orchestrate all the different services and understand when you need to push the lever of intensity up for different services and when you need to pull that back,” he said. “DispatchHealth has invested a lot of resources in building technology to orchestrate that care safely inside the home, and then also to enable our virtual services to monitor them through virtual nursing.”
Demonstrating the effectiveness of technology and how that drives outcomes is a key factor in proving hospital-at-home viability. DispatchHealth will point to clinical outcomes, patient experience and cost savings when advocating for hospital-at-home.
“Typically, hospitals see a 20% readmission rate on average,” Riddleberger said. “We are seeing a 6% 30-day readmission rate for our patients and 0% SNF utilization.”
Net promoter scores for Dispatch’s hospital-at-home patients is 97 and cost savings is anywhere between $5,000 to $7,000 per episode.
More flexibility needed
Securing an extension for the hospital-at-home waiver program is step one. However, Riddleberger believes some changes could be made for how patients are identified in this program as well.
“I think you’ll hear industry leaders that are in this space want the exact same thing: that not every patient needs to identify themselves for these programs in the E.R.,” he said.
As it stands now, patients first have to be admitted into the emergency room before they can be admitted to the home for acute and chronic needs.
“The CMS waiver does not allow for that flexibility,” Riddleberger said. “Moving forward, in order to make a meaningful impact, we need to be able to provide the ability for organizations to identify these patients outside of just the ER to be admitted to the program.”
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