Hospital-At-Home Stakeholders Push For Acute Hospital Care at Home Waiver Extension

The largest hospital-at-home players are again pleading with lawmakers in Washington, D.C., to extend the Acute Hospital Care at Home waiver.

The waiver – which is largely responsible for hospital at home’s considerable growth over the last three or so years – is set to expire on Dec. 31.

In a letter to the Senate majority leader and Senate minority leader – Sens. Chuck Schumer (D–N.Y.) and Mitch McConnell (R–Ky.), respectively – dozens of providers asked for “at least a five-year extension” to the waiver program.


“The undersigned stakeholders, representing hospital-at-home (HaH) programs, physicians, physician assistants, pharmacists, nurses, emergency medical technicians, paramedics, patient advocacy organizations, hospitals, health systems, and care model enablers, are writing to ask for at least a 5-year extension of the Acute Hospital Care at Home waiver program (AHCaH) before its expiration at the end of 2024,” they wrote. “Without an extension, Medicare beneficiaries will lose access to HaH programs that have been demonstrated to provide excellent clinical outcomes and lower the costs of care.”

As of Feb. 14, 313 hospitals and 131 health systems across 37 states were participating in the waiver program.

Since the Centers for Medicare & Medicaid Services (CMS) launched the Acute Hospital Care at Home waiver in late 2020, patients have experienced positive outcomes.


Specifically, from November 2021 to March 2023, only 7.2% of patients treated in the home were transferred to the hospital, according to a study published in JAMA. Only 39 unexpected deaths were reported – just 0.34% of patients. Most of those deaths were due to a progression in COVID-19 symptoms.

Health systems have invested heavily in the model, both in and outside of the waiver program. Medicare Advantage plans, too, have begun to fund hospital-at-home care.

Last month, Sens. Marco Rubio (R-Fla.) and Tom Carper (D – Del.) also introduced the At Home Observation and Medical Evaluation (HOME) Services Act. That would allow hospital-at-home providers to care for “observation status patients,” and not just acute patients. Observation status patients are generally ones waiting to hear from a health system whether they will be admitted to the hospital or not.

Obviously, the HOME Services Act would be contingent on an Acute Hospital Care at Home extension.

The chief architect of Medically Home’s hospital-at-home program, Dr. Pippa Shulman, recently told Home Health Care News that the care model is reaching a “tipping point” in the U.S.

Providers are invested in the model. Patients are aware of the model, and prefer it to brick-and-mortar care.

But there still remains some financial uncertainty moving forward.

“Not a week goes by now where we don’t hear a story of a patient or a family member asking for hospital at home,” Shulman, the chief medical officer at Medically Home, said. “The word is out, and that gets me really excited. But the health care system more broadly needs to catch up with where patients and families are at. That tipping point is coming.”

The model has bipartisan support, too. Stakeholders just need lawmaker action to follow.

“To achieve this future, the waiver must be extended to enable hospitals and health systems nationwide to continue building out the logistics, supply chain, and workforce for Hospital-at-Home (HaH) and to encourage multiple payers outside the Medicare program, including Medicaid programs, to enter the HaH market,” the letter read. “An extension will also allow home-based services to be developed equitably across populations everywhere and ensure hospital inpatient unit care is available for the patients who need it while enabling patients who can and want to be treated in their home to have the opportunity to do so, creating needed capacity for hospitals without increasing health system costs.”

Best Buy Health, GE HealthCare (Nasdaq: GEHC), Kaiser Permanente, DispatchHealth, Moving Health Home, Biofourmis, Right at Home, Inbound Health and Henry Ford Health are among the many companies that signed the letter.

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