The House of Representatives’ Ways and Means Committee held a hearing Tuesday focused on enhancing access to care-at-home in rural and underserved communities.
The topic of the hearing is especially pressing because individuals living in rural communities often face barriers that prevent them from receiving adequate care.
“For patients in rural and underserved communities, bringing health care home is a lifesaver,” House Ways and Means Committee Chairman Jason Smith (R-Mo.), said during the hearing. “These communities struggle with access to health care, which results in worse health outcomes, compared to wealthy urban areas. Americans living in small towns often have fewer health services close by and rural Americans have to drive farther to get critical care. We’re already seeing these patients take advantage of care-at-home options.”
Smith noted that rural end-stage renal disease (ESRD) patients are 22% more likely to receive dialysis at home, compared to individuals living in larger cities. Plus, audio-only telehealth increases access for rural and underserved people who don’t have reliable internet.
Though the hearing covered various areas of high-acuity care-at-home, including telehealth and home dialysis, one of its key areas of focus was hospital-at-home, as the Acute Hospital Care at Home waiver is set to expire Dec. 31.
Dr. Nathan Starr, the medical director of home services for Intermountain Health, gave testimony that deemed essential providers’ ability to move care away from hospitals.
Intermountain is a nonprofit system with 33 hospitals and 385 clinics. The health system has locations in seven states. It also has a number of care-at-home programs under its roof, including home health care, primary care, hospital-at-home and more.
Intermountain’s hospital-at-home program has provided care to over 1,200 patients, has had zero serious in-home safety events, has achieved lower hospital readmissions and has freed up more than 4,000 physical patient bed days.
“We are just beginning to scratch the surface of what we can do in the home and in communities,” Starr said during the hearing.
Starr noted that the day of the hearing coincided with the grand opening of Intermountain’s hybrid community health clinic which combines telehealth and in-person services. The clinic is being opened in Wells, Nevada, a town made up of 1,200 people whose closest clinic, prior to Intermountain, was a roundtrip of 100 miles.
Starr — also speaking in his capacity as a Moving Health Home member — urged the House to pass the Expanding Care in the Home Act.
“This legislation … will remove barriers that currently limit our ability to care for patients in the home,” he said.
What’s more, he pushed for a five-year extension of the Acute Hospital Care at Home waiver.
“This will allow the needed time to gather data to develop a permanent regulatory, clinical and financial model that will make hospital-at-home a success for everyone,” Starr said. “If Congress fails to act to extend the hospital-at-home program, we will be forced to rollback the program and lose the important gains we have made. What makes me so passionate and excited about moving care into the home is, if we do this right, then hospitals, health systems, communities, payers, and most importantly, patients will all win.”
During the hearing, telehealth was also in the spotlight due to its ability to extend care beyond clinics, hospitals and doctor’s offices.
“If you have ever supported a family member following a hospitalization, you likely struggled with confusing printed instructions and a laundry list of medications,” Chris Altchek, founder and CEO of Cadence, said during his testimony. “If you have helped a family member with type 2 diabetes, you know how hard it is to titrate their insulin. Many of your constituents are frustrated because clinics are too far away. They can’t get in to see their doctors and when they finally get appointments, they’re rushed. The vast majority of Americans are facing these challenges.”
New York-based Cadence is a provider of remote monitoring for patients living with chronic conditions. Currently, the company monitors patients from home across 20 states, including almost 12,000 patients in rural and underserved communities.
Monitoring patients at home has helped prevent health issues from progressing to ER visits, hospitalizations, as well as long-term disability or death, according to Altchek.
Additionally, the company saw a 23% decrease in patients’ total cost of care, inclusive of the incremental costs associated with RPM services.
As for policy change, Altchek called on the committee to fix regional payment disparities that penalize rural communities.
“Reimbursement is lowest in the communities that need it most,” he said. “Missouri remote monitoring pays 33% lower than remote monitoring in San Francisco. The old way, adjusting Medicare payments by geography, doesn’t make sense in a technology enabled-system. Devices, connectivity and staff all have the same cost, regardless of location. It’s an important change to an unintended policy.”
He also called on the committee to ensure that national payment rates stay in line with Medicare.
“Remote monitoring rates have declined up to 28%, since being introduced in 2018, substantially more than Medicare rates,” Altchek said. “I encourage policymakers to look at the data and decide what kind of health care future we want for our country.”
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