Photo: supersizer/Getty Images
Hackensack Meridian Health, based in Edison, New Jersey, has launched a program called Hospital At Home at JFK University Medical Center, also in Edison. The program will deliver acute care in the home of a Medicare patient, and the health system expects it may ultimately be scalable to the larger patient population.
With healthcare increasingly expanding beyond hospital walls, Hackensack is banking on the program improving outcomes and patient satisfaction, as well as making care more affordable.
The program is created through a Medicare waiver, which permits hospitals to provide acute care at home to Medicare patients. The network will select patients based on factors that include diagnoses that often result in frequent and costly readmissions to hospitals: uncomplicated Congestive Heart Failure (CHF), pneumonia, Chronic Obstructive Pulmonary Disease (COPD) and cellulitis.
Initially, the program will admit a few patients per week and provide a number of services in the home, including two nursing visits daily; medication delivery, including infusions; rehab visits as needed; and remote patient monitoring, which includes pulse ox, blood pressure, heart rate, weight and temperature. Nutritious meals and home health support can be provided as needed.
WHAT’S THE IMPACT
The program was created during the COVID-19 pandemic to help hospitals struggling with bed capacity. In November 2020, the Centers for Medicare and Medicaid Services released a waiver called the Acute Hospital Care at Home Waiver allowing for hospitals to bill for acute care services that patients receive at home.
Research has shown the programs are at least as safe as inpatient care and result in improved clinical outcomes, higher rates of patient satisfaction and reduced healthcare costs, according to Hackensack. Patients have indicated they want to receive care at home, especially during the pandemic: According to a recent survey, 85% of adults say it should be a high priority for the government to expand Medicare coverage for at-home healthcare.
Ultimately the network plans to expand the program to other hospitals once the pilot is proven successful. And Hackensack believes their hospital at home program can be scaled significantly to include patients who are not covered by Medicare.
Another long-term goal is to expand care in underserved communities in which transportation may be an issue – part of a broader strategic priority to reduce inequality in care delivery.
THE LARGER TREND
Hospital At Home is a name trademarked by Johns Hopkins University in 2010.
Many hospitals have been adopting their own model. The hospital at home program has been in practice in some form since at least 2002. The concept is not new, but like telehealth, at-home hospital-level services became a necessity for all health systems when acute care beds filled during the first surge of the COVID-19 pandemic.
During the COVID-19 public health emergency, CMS is reimbursing for hospital at home acute-level care and has a list of appropriate DRGs. In general, these are diagnoses that are medical in nature, with lower acuity, and not post-surgical care.
Like telehealth, CMS is reimbursing for this care during the PHE. Once the public health emergency ends, CMS will be evaluating these services for the future.