Hospital-at-home (HaH) programs are becoming a powerful force in patient care, giving providers the ability to effectively monitor and manage patients without the need for an in-facility stay. And since the pandemic, the use of these programs has only grown, especially in American hospitals. Here’s a closer look at the economic forces driving this expanded use of hospital-at-home programs.
In Case You Missed It: An introduction to Hospital-at-Home, and How RPM Enables It
5 Economic drivers behind hospital-at-home programs for healthcare organizations
As we discussed in our overview of HaH, hospital-at-home programs give healthcare providers the power to treat acute-care patients remotely — and to receive greater reimbursement than before for doing so. Thanks to telehealth technology like remote patient monitoring (RPM), the technology and platform for treating patients at home is accessible and affordable for most organizations.
What’s more, it’s also beneficial to patient care. As Bruce Leff and Arnold Milstein write at Health Affairs, studies of hospital-at-home programs have consistently “produced a robust evidence base demonstrating that HaH provides high-quality, safe, equitable, and effective care.”
With the public health emergency (PHE) still in place, the economic benefits offered by hospital-at-home programs have never been more promising. To help healthcare providers better understand this moment of opportunity, here’s a closer look at the five main economic forces driving current growth in the use of hospital-at-home programs.
#1: Demand for new lines of service
Patient demand for home-based care is stronger than ever since the pandemic. According to one study cited by Susan Morse at Healthcare Finance, 61% of all patients today “would choose to be at home” when given the choice “between having inpatient-level care at home or in the hospital.”
By implementing hospital-at-home programs, then, facilities can effectively expand their offerings to meet this increased demand. And this includes not only the at-home delivery of acute care, but also different types of services, too, like skilled nursing or home infusion. In fact, implementing a working hospital-at-home program requires these types of integrated services, as Morse points out.
To deliver effective hospital-at-home programs, hospitals “must already have, or be willing to invest in skilled nursing staffing, physician telehealth and other technologies to coordinate the delivering and sequencing of services, supplies such as oxygen, and nursing schedules,” she notes.
#2: The need for expanded staffing efficiency
Yet the facilities that do invest in these updates to their infrastructure will see other benefits. Expanding the use of telehealth technology also gives clinical teams the chance to do more with less. Richer, more frequently delivered and more relevantly reported patient data means critical care decisions can be made and assessed in less time, and with less labor, than ever.
At a time when staffing shortages are hitting clinical facilities hard, and post-acute organizations harder still, hospital-at-home programs can help providers stay operational amid workforce uncertainties. Physicians, or qualified clinical staff working under their direction, can more effectively monitor more patients from a central hub, and in a way that doesn’t sacrifice quality of care or patient satisfaction but actively contributes to them.
#3: The need for expanded facility capacity
Hospital-at-home programs are also surging in use because of their ability to make up for limited bed space. In particular, academic hospitals have used the programs “as an alternative to the more expensive alternative of building new bed space,” writes Morse, pointing to UMass Memorial Health’s new hospital-at home-program as one example.
Commercial facilities are seeing other types of financial benefits, including the expansion of Medicare Advantage (MA) participation. Hospitals with HaH programs also have the potential to “backfill a lower-acuity patient from the hospital to the home, for a patient with a higher acuity-level and higher margin,” Morse points out.
This ability to boost patient capacity beyond physical limitations can help provide stability during normal yearly fluctuations, as well as during “future strains in hospital capacity, whether from a once-a-century pandemic, seasonal population swells (for example ‘snowbirds’) influenza outbreaks, and increasingly common climate-related strains due to heat waves, flood, or other disasters,” write Leff and Milstein.
#4: Expanded reimbursement from the Centers for Medicare & Medicaid Services (CMS)
In their Health Affairs piece, Leff and Milstein call for an extension of what has been, by far, the biggest economic driver of hospital-at-home programs recently — the PHE waiver offered by the Acute Hospital Care At Home program.
The program was put in place as an emergency measure in November 2020 as many hospitals were “meeting or exceeding capacity” from Covid-19, as an analysis published in NEJM Catalyst explains. By waiving a few Medicare regulations, like the 24-hour, on-site nursing requirement, the program allowed hospitals to offer more “inpatient-level care” to patients at home.
In the almost two years since, the program — which is still in place — has spurred remarkable growth in the use of hospital-at-home programs. Leff and Milstein observe that 227 hospitals in 35 states — or “nearly 4 percent of all US hospitals” today — had used the waiver as of May 2022, up from about two dozen programs in place before the Acute Hospital Care At Home program.
And, with lawmakers extending the PHE into 2023, there’s more than a slight indication that officials want to keep programs like this place, or at least, implement a similar reimbursement plan. After all, the program hasn’t just allowed for the expansion of at-home care. It’s also “spurred significant new interest and adoption of HaH in Medicare Advantage, Veterans Affairs care, accountable care organizations, and commercial health insurance plans.”
#5: Offering a framework for future growth
By including a strict application process that lets CMS assess the safety of the care delivered, participation in the Acute Hospital Care At Home Program commits facilities to reporting patient-level data on a monthly minimum basis. The knock-on effect of this feature is to provide safety standards and an infrastructural framework for new hospital-at-home programs.
In other words, the program is driving not only the expanded use of technological solutions, but also the use of a shared framework and set of accepted standards. As such, the continued use of the program’s waivers could help to raise the standard of remote care in a broader sense, and help guide facilities as they continue to build out their telehealth offerings in the future.
CareSimple’s EHR-integrated platform combines telehealth and remote patient monitoring in one single access for patients and clinicians. To learn more how we can help you offer hospital-at-home programs, contact our team.