Whether Hospital Care at Home Continues When Pandemic Emergency Ends Is Up to Congress

Among the many regulatory flexibilities enacted by HHS during the pandemic, the ability for providers and patients of all ages to use telehealth may be among the best known. In a Viewpoint published in JAMA Health Forum, 2 prominent scholars highlight the possibilities of another one of those HHS adjustments—hospital care at home for Medicare beneficiaries—continuing after the public health emergency (PHE) ends.

Initially, after the PHE began, CMS created the Hospitals Without Walls program in March 2020, with the intent to ease the inpatient crisis and extraordinary demand placed on hospitals, with the ability to provide acute care in other locations, such as ambulatory surgery centers, inpatient rehabilitation hospitals, hotels, and dormitories.

In November 2020, it was expanded to include acute care within the home under the Acute Hospital Care at Home program.

Last month, the Biden administration extended the COVID-19 PHE from July 15 to October 15. Without another extension, the waivers, upon which the health care industry has come to rely, expire.

Under the Acute Hospital Care at Home program, if Medicare beneficiaries are successfully assessed and deemed a suitable fit, they are provided with the appropriate technology and remote patient monitoring and are visited twice daily by a registered nurse.

The idea of “hospital care at home is a health care delivery paradigm whose time has come,” wrote Eli Y. Adashi, MD, MS, the former dean of medicine and biological sciences at Brown University, and I. Glenn Cohen, JD, the deputy dean and faculty director at the Petrie-Flom Center for Health Law Policy, Biotechnology and Bioethics at Harvard Law School.

A survey conducted last year by an alliance of health care organizations, called Moving Health Home, formed after the temporary regulatory changes occurred, found that 73% of Democrats and 61 % of Republicans support the idea of federal policy allowing for more care delivery in the home.

In March, bipartisan legislation was introduced in both houses of Congress to keep the home-based hospital programs in place for another 2 years once the PHE ends.

Senators Thomas R. Carper, D-Delaware, and Timothy E. Scott, R-South Carolina, introduced the Hospital Inpatient Services Modernization Act (S 3792).

The companion bill (HR 7053) in the House of Representatives was introduced by Earl F. Blumenauer, D-Oregon, and Brad R. Westrup, R-Ohio.

In addition to the 2-year extension, the bill calls for the HHS secretary to issue health and safety regulations and evaluate care quality, patient outcomes, beneficiary access, health disparities, patient safety, cost, and utilization, as well as issue a report to Congress regarding the findings and related recommendations.

The bill has the support of the American Hospital Association, the Association of American Medical Colleges, and other organizations.

However, whether the bill can survive “legislative gridlock brought on by the approaching midterm elections,” remains to be seen, Adashi and Cohen note.

Reference

Adashi EY, Cohen IG. Acute hospital care at home in Medicare—will a pandemic policy be sustained? JAMA Health Forum. 2022;3(8):e222564. doi:10.1001/jamahealthforum.2022.2564