The Acute Hospital Care at Home program has been outlined in a research letter published in the Journal of the American Medical Association Health Forum. The program is a development in healthcare delivery, particularly during the COVID-19 pandemic after it was initiated by the Centers for Medicare and Medicaid Services (CMS). It was initially granted waivers to hospitals to provide acute level care in patients’ homes. The concept, though not new and practiced by institutions like Johns Hopkins since 2002, found relevance during the pandemic. The necessity to provide acute services outside the conventional hospital setting was a response to the overwhelming number of COVID-19 patients filling hospital beds, alongside the need to treat other patients in the safety of their homes. The program’s success during the pandemic led to the Consolidated Appropriations Act of 2023 extending the initiative through December 31, 2024, continuing the waivers and flexibilities for home-based care and telehealth.
The structure of the Acute Hospital Care at Home program is extensive. As of March 2023, 277 hospitals across 123 systems in 37 states were approved to participate in this program. This initiative allowed for patients requiring acute-level care, who would typically be admitted to a hospital, to receive comparable care at home. The program covered a wide range of patients, with 11,159 patients admitted under the waiver from November 2021 to March 2023. These patients presented with various conditions, predominantly respiratory infections, heart failure, and severe sepsis or septicemia, often accompanied by major complications and comorbidities. The median length of stay for Medicare patients was five days, and the overall transfer rate back to the hospital was just 7.20%. This data shows the program’s effectiveness in managing a range of acute conditions in a home setting.
The results of this initiative are telling of its effectiveness. The low mortality rate and minimal complications related to escalations back to the hospital are particularly positive. During the study period, only 38 unexpected deaths occurred among the participating hospitals, most of which were in the context of COVID-19 infections and subsequent severe illness progression. These deaths, excluding three cases, occurred after the patients had been transferred back to hospital care, suggesting that the Acute Hospital Care at Home program was effective in managing patient care up to the point of requiring more intensive hospital-based treatment. This outcome indicates a successful implementation of the program, providing high-quality care while alleviating the strain on hospital resources during a critical period.
It is important to consider the program’s limitations and challenges. One significant limitation highlighted in the study is the potential selection bias from hospitals choosing to participate and patients suitable for home-based care. This bias suggests that the results may not be universally applicable to all patient populations or healthcare settings. The waiver’s conditions also required hospitals to demonstrate their ability to meet certain unwaived Conditions of Participation (COP) in the home environment. These included providing services such as pharmacy, infusion, diagnostic testing, and ensuring safety elements like daily clinician visits and emergency response capabilities. Due to these limitations, the success of the program requires both the concept of home-based care, and the participating hospitals’ capacity to meet these large requirements and maintain the quality of care equivalent to in-hospital treatment.
