Might Your Next “Hospital Stay” Be at Home? 

Q. My friend’s father recently suffered from pneumonia. Rather than being admitted to the hospital, he was offered another choice: hospital-level treatment in his home. I had never heard of such a thing. Is this type of care common? And is it covered by Medicare? Thanks so much for your help!

A. Since the COVID-19 pandemic began, “hospital-at-home” programs have become a popular option for providing high-quality acute care at home, eliminating the need for hospital stays. This concept is not new, but the COVID-19 public health emergency accelerated what was an already burgeoning movement of bringing health care into the home.

Hospital-at-home has become a popular option for many patients. However, not all patients are eligible for hospital-at-home care, such as those experiencing chest pain, stroke symptoms, severe abdominal pain, or drug overdoses. Dozens of other common conditions, though, including congestive heart failure, urinary tract infections, shortness of breath, and diarrhea can be treated at home. 

Hospital-at-Home Was Started Locally 

Hospital-at-home was started right here in the DMV by Johns Hopkins University School of Medicine in 1995. Today, Hopkins Hospital-At-Home is offered through six Veterans Affairs Medical Centers and three other hospitals.  

Since then, 114 hospital systems, comprising 260 hospitals in 37 states, have adopted and implemented a hospital-at-home program. Despite their presence in the United States for nearly 30 years and studies attesting to their positive impacts, hospital-at-home programs have not been widely available to consumers until recently.  

Benefits of Hospital-at-Home Care Model 

Since the inception of the program, the following have been some of the benefits of hospital-at-home programs: 

  • Hospital-at-home programs can increase the accessibility and availability of health care services for patients; 
  • At-home visits by medical personnel also allow for the patient’s social determinants of health to be assessed, which can lead to more well-rounded care; 
  • With less time spent inside the walls of an institutional setting full of sick people, patients using these programs have less of a chance of developing hospital-acquired infections; 
  • There have been lower rates of readmission and reductions in mortality with this care delivery model.  

Research That Hospital-at-Home Works 

As mentioned, research has shown that hospital-at-home programs can improve patient experience and outcomes by reducing mortality, improving recovery, and reducing readmissions. 

A 2020 clinical trial in the Annals of Internal Medicine found that costs for treating acutely-ill patients at home were 38 percent lower compared to a hospitalized group. The in-home patients received fewer lab tests, radiology exams, and specialist consultations, and they were less sedentary. Their readmission rates were also lower. 

A more recent study published in JAMA Network Open involved a review of outcomes following hospital-at-home care vs. in-hospital stays. Researchers found that patients who participated in hospital-at-home care experienced lower depression and anxiety levels compared to those who received care in a hospital. 

Another recent study published in the American Journal of Accountable Care reviewed costs and care utilization among older adults who moved from hospitals to hospital-at-home care. Using measurements such as propensity score for cost determination, hospital admissions, and emergency department visits, researchers found that organizations could benefit from home-based care delivery methods as it enables high-quality care at lower costs. 

Is Hospital at Home Covered?  

Amid concerns about hospital capacity during the pandemic, CMS introduced waivers to extend care outside the physical hospital setting. As part of this extension of care, in November 2020, CMS created the Acute Hospital Care at Home (AHCaH) individual waiver program, which allowed qualifying hospitals to offer acute inpatient care in the home. The program provides similar services as those administered during inpatient visits, such as physician visits and monitoring, drug prescription, nursing services, diagnostics, etc. The CMS waiver program solely serves beneficiaries with Original Medicare (not Medicare Advantage plans) and non-managed care Medicaid. 

Since its inception, 144 systems including 260 hospitals across 37 states have utilized the AHCaH waiver, rapidly increasing the number of hospital-at-home programs in the United States. While the initiative was originally set to expire with the end of the pandemic, the Acute Hospital Care at Home (AHCaH) individual waiver program was extended until December 31, 2024, with the passing of the Consolidated Appropriations Act, 2023 (CAA 2023) 

The extension of this program emphasizes the importance of permanently integrating home-based care delivery models into our health care system. Unfortunately, despite the lengthy extension, the nature of this waiver program remains temporary. The 2024 expiration of the AHCaH waiver program would decrease the number of hospital-at-home programs available, making it more difficult for Medicare patients to receive quality care from the comfort of their home. 

Besides the waiver program, there are other ways to pay for hospital-at-home services. Existing hospital-at-home programs also partner with other payers, such as Medicare Advantage, commercial, and managed Medicaid plans, for reimbursement. In addition, hospital-at-home programs that operate outside of the CMS waiver may admit patients from the community and therefore do not require patients to first be seen in the ER or admitted to the inpatient hospital setting. 

Virginia Health System Creates Hospital-at-Home Program  

As mentioned, Maryland has a hospital-at-home program at Johns Hopkins University, which was the first of its kind. In Virginia, Virginia Commonwealth University (VCU) Health has recently implemented a hospital-at-home program as well, which has a goal of providing acute care at home to 2,000 patients in its first year. The program will be available to patients battling conditions such as heart failure, pneumonia, and sepsis. The program’s goal is to expand care access without the need for travel and in-hospital stays. VCU Health will provide home hospital-level care through video and remote patient monitoring tools. Physicians will oversee patients in the program both virtually and in person. Acute care nurses will also visit patients in person. Supplies will be delivered to the patient’s home. 

Washington, DC, does not have hospital-at-home programs at this time.  

The Future of Hospital-at-Home Programs 

Hospital and home-care coalitions are calling on CMS to develop a demonstration project for a new reimbursement model for hospital-at-home programs serving Medicare beneficiaries. The hope is to transition the temporary AHCaH waiver into a permanent part of the health care delivery system. Hopefully, COVID-19 era waiver flexibilities, including hospital-at-home programs, telehealth services, and home health agencies, will develop into permanent fixtures of the health care system.  

When It’s No Longer Safe for a Loved One to Stay in Their Home 

Most people want to stay in their home for as long as possible. However, if you or a loved one cannot live independently and are showing signs that living alone is a strain, it may be time to consider other alternatives. 

Whether the outcome is in-home care, an assisted living community, or a nursing home, it is always wise to plan ahead. Life Care Planning and Medicaid Asset Protection is the process of preventing people from having to go broke in connection with paying for nursing home level care at home, or going into an assisted living community or nursing home, while also helping ensure that you and your loved ones get the best possible care and maintain the highest possible quality of life. Please contact us whenever you’re ready to make an appointment for an initial consultation (and please note we have a brand-new office location in Annapolis, Maryland, to help serve our clients throughout the state of Maryland): 

Elder Care Attorney Northern Virginia: 703-691-1888 
Elder Care Attorney Fredericksburg, VA: 540-479-1435 
Elder Care Attorney Rockville, MD: 301-519-8041 
Elder Care Attorney Annapolis, MD: 410-216-0703 
Elder Care Attorney Washington, DC: 202-587-2797 

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About Evan H Farr, CELA, CAP

Evan H. Farr is a 4-time Best-Selling author in the field of Elder Law and Estate Planning. In addition to being one of approximately 500 Certified Elder Law Attorneys in the Country, Evan is one of approximately 100 members of the Council of Advanced Practitioners of the National Academy of Elder Law Attorneys and is a Charter Member of the Academy of Special Needs Planners.