Since the Covid-19 pandemic, Medicare has been paying hospitals to treat patients at home, instead of in hospital, under its Hospital at Home program. Medicare pays hospitals the same rate for the care of these patients as it pays for hospital patients, including a facility fee. But, is the Hospital at Home program delivering benefits to patients?
Under the Hospital at Home program or H@H, patients with 60 acute conditions, such as pneumonia, urinary tract infections or congestive heart failure can sometimes opt to get their hospital care at home, reports Richard Eisenberg for Fortune. The goal of H@H is to provide a more comfortable and safer care environment to patients. Patients are prone to fall in the hospital as well as to experience delirium.
H@H has been around a long time both in and outside the United States, but it is only recently that Medicare has adopted it. Hospitals appear to value the hospital at home program for people with Medicare. After all, they are generating the same revenue through the program that they would receive if patients were in hospital, without the facility costs.
But, unless Congress acts, the program will end in December of this year. The American Hospital Association is arguing for a five-year extension of the program. It offers little data to demonstrate the value of the program.
Congress is likely to extend Medicare’s Hospital at Home program another five years even though there’s no good data to show better patient outcomes from the program and it is not saving the Medicare program any money, reports Jessie Hellmann for Roll Call.
The Medicare Payment Advisory Commission reports that the program is not structured to deliver meaningful information on health outcomes and costs or to allow comparisons between patients treated at home and patients treated in a hospital facility. It wonders whether patients in the program are falling less frequently than patients in the hospital and whether they are experiencing fewer infections.
How does the Hospital at Home program work? Hospitalized patients at participating hospitals can decide whether they want H@H. Generally, they are in need of four or five more days of hospital care. Participating hospitals are required to send clinicians to your home twice every day. A physician must “see” the patient each day as well, though the physician can do so remotely. Patients must be able to reach the hospital 24 hours a day. And hospitals must be able to respond to patient emergencies within 30 minutes,
Among other things, H@H can provide IV antibiotics and infusions to patients at home. They can receive EKGs and X-rays. The hospital can monitor their blood pressure. And, they can get oxygen therapy.
The program is still relatively small. Since its inception, just 328 hospitals in 37 states have participated, and 23,000 patients have been discharged from hospital into the program.
National Nurses United does not support the H@H program. It calls it “Home All Alone.” Indeed, people can be sent home for their hospital care without a caregiver to be with them. That leaves them without the round-the- clock nursing care they receive in the hospital. And, what if the remote monitoring technology misfunctions or there’s an emergency and the patient can’t get the prompt attention that’s needed?
Here’s more from Just Care:
