Mayo Clinic and Kaiser Permanente formed a new coalition to push HHS and Congress to maintain their home hospital programs and investments after the pandemic.
Hospitals across the country have spent heavily on moving acute care home to patients as COVID-19 tested the safety and ability of systems to continue to care for patients within their facilities. For example, Mayo and Kaiser invested $ 100 million in Medically Home in May, which partners with systems to provide services such as emergency care and cancer care. Many other members of the new coalition also use the company, such as Adventist Health, ProMedica and UNC Health. Other systems have created their own programs.
Eventually, the national public health emergency that allowed CMS to create the Hospital Sin Muros program will end and reimbursement for these services will stop. This new sector has exploded thanks to new payments, which were previously largely restricted to special populations.
The Advanced Care at Home Coalition will work on creating a plan for a new Medicare & Medicaid Innovation Center model that would allow providers to request continued long-term flexibilities. But CMMI models typically take years to develop and implement, so they are also working on a bill that Congress could pass to expand Hospital Without Walls if there is a hard stop to the public health emergency.
“It would be a substantial disruption for providers,” said Mara McDermott, executive director of the new coalition. “All of this infrastructure has been in place. But there is also a very strong patient care component to the outage that it would really be a shame to have lost all this progress that we have made during the pandemic.”
Health systems are also gathering information on how intensive home care programs have seen changes in Medicare costs, patient experience, quality outcomes, and health equity.
That data will be critical as home hospital programs question the logistics of providing your care. While there is research showing that some of these programs increased inpatient capacity, it is unclear whether quality results were sustained or whether the programs need new quality and safety metrics.
Anne Tumlinson, CEO and founder of long-term care consultancy ATI Advisor, said it will be crucial to make sure there are no racial or socioeconomic factors that affect whether patients can receive a level of hospital care at home.
“I think these points point to the big challenge that legislators will face next year when the public health emergency is over: they are going to have to make some tough decisions about which new care modalities (like home hospital or telehealth) to keep or discard. “. Tumlinson said. “The main challenge will be to design new permanent programs under financial incentives that emphasize value over volume.”
Another coalition, called Moving Health Home, was formed earlier this year, with Intermountain Healthcare and Ascension, along with several home care companies, including home hospital provider Dispatch Health and complex home care provider Signify Health, that address a much broader problem. schedule. The group wants Medicare to pay for EMT services even when the patient is not taken to the hospital, and to expand a package model that serves as an alternative to stays in a skilled nursing facility.
Tumlinson said it is crucial to have groups that focus on addressing questions about how programs have worked, but cautioned that systems and policy makers should continue to focus on prevention of hospitalizations and public health.
“There is no question that we need to reduce the use of inpatient hospital care,” Tumlinson said. “But is the solution just to change the settings for this level of care or to prevent it in the first place?”