The healthcare landscape is continuously evolving, and with recent advancements, receiving hospital-level care in the comfort of your home is becoming a tangible reality. The Centers for Medicare & Medicaid Services (CMS) has recognized this shift and, particularly in response to healthcare capacity challenges, introduced the Acute Hospital Care At Home program. This initiative builds upon the foundation of the Hospitals Without Walls program, offering greater flexibility for hospitals to extend their reach and provide acute inpatient services beyond the traditional hospital setting. This approach raises many questions for patients, healthcare providers, and institutions alike. This article addresses frequently asked questions about the Acute Hospital Care At Home program, providing essential information to understand this innovative healthcare model.
Understanding the Acute Hospital Care At Home Program
The Acute Hospital Care At Home program is an extension of the earlier Hospitals Without Walls initiative launched by CMS. It is specifically designed to allow hospitals to care for patients who require acute inpatient care in alternative locations, most notably, their own homes. This program emerged as a crucial strategy to manage healthcare demands, especially during periods of increased strain such as the COVID-19 pandemic. By providing regulatory flexibility, CMS enables hospitals to maintain and even expand their capacity to treat patients effectively, without being confined by the physical limitations of hospital buildings.
This program is not a blanket solution for all hospital admissions. It is carefully structured with specific protocols to ensure patient safety and quality of care. A cornerstone of the program is the mandatory in-person physician evaluation. This initial assessment is critical to determine if a patient’s medical condition and home environment are suitable for receiving acute care at home. The evaluation process also includes screening for non-medical factors that could impact the success of at-home care, ensuring a holistic approach to patient well-being.
Who is Eligible for Acute Hospital Care at Home?
Eligibility for the Acute Hospital Care At Home program is determined through a rigorous screening process. Patients can be considered for this program if they are being admitted to the hospital from two primary locations: the emergency department or an inpatient hospital bed. This ensures that the program caters to individuals who genuinely require acute inpatient level care.
Before a patient can commence receiving care at home, a qualified physician must conduct an in-person evaluation. This evaluation is not just about the patient’s medical condition; it also encompasses an assessment of their home environment. Factors such as the safety and suitability of the home for medical equipment and care delivery are taken into account. This dual assessment – medical and non-medical – is vital to ensure that at-home care is a safe and effective option for each individual patient.
How Does Acute Hospital Care at Home Work in Practice?
Once a patient is deemed eligible and enrolled in the Acute Hospital Care At Home program, a structured care plan is implemented. A key component of this plan is continuous monitoring and regular in-person and remote evaluations. A registered nurse (RN) is required to evaluate each patient daily. This evaluation can be conducted either in person at the patient’s home or remotely, leveraging telehealth technologies.
Furthermore, depending on the patient’s nursing plan and the hospital’s policies, either registered nurses or mobile integrated health paramedics must conduct at least two in-person visits to the patient’s home each day. These visits are crucial for hands-on care, monitoring, and addressing any immediate medical needs that may arise. This blended approach of remote and in-person care ensures that patients receive timely and appropriate medical attention while benefiting from the comfort of their home environment. Hospitals participating in the program are also mandated to report quality and safety data to CMS. The frequency of this reporting is determined by the hospital’s prior experience with providing acute hospital care at home, ensuring accountability and continuous quality improvement within the program.
Which Health Systems are Leading the Way in Acute Care at Home?
CMS has initially approved waivers for several health systems that have demonstrated significant experience and expertise in providing acute hospital care at home. These pioneering institutions include:
- Brigham and Women’s Hospital (Massachusetts)
- Massachusetts General Hospital (Massachusetts)
- Huntsman Cancer Institute (Utah)
- Mount Sinai Health System (New York)
- Presbyterian Healthcare Services (New Mexico)
- UnityPoint Health (Iowa)
These health systems are at the forefront of implementing and refining the Acute Hospital Care At Home model. Their participation provides valuable real-world insights and best practices that can guide other hospitals interested in adopting this innovative care delivery approach.
How Can Hospitals Apply to Participate in the Program?
Hospitals seeking to participate in the Acute Hospital Care At Home program need to apply for a waiver through CMS’ online portal. The application process is accessible through the QualityNet website provided by CMS. The level of detail required in the waiver request varies based on the hospital’s previous experience with delivering acute hospital services at home.
For hospitals with limited experience (treating fewer than 25 patients with acute hospital services at home previously), a more comprehensive and detailed waiver request is necessary. This ensures that CMS can thoroughly assess the hospital’s readiness and capacity to provide safe and effective at-home acute care. This tiered approach to the waiver application process allows CMS to appropriately evaluate hospitals based on their experience level, promoting responsible and safe program expansion.
Where Can I Find More Detailed Information and FAQs?
For those seeking more in-depth information, CMS has provided a dedicated Frequently Asked Questions (FAQs) document specifically for the Acute Hospital Care at Home program. This document is an invaluable resource for understanding the nuances of the program, eligibility criteria, operational guidelines, and regulatory requirements. The CMS FAQs can be accessed directly here.
Additionally, the American Hospital Association (AHA) Value Initiative offers several resources related to hospitals-at-home models. These resources include webinars, case studies, and issue briefs that provide further insights into the practical implementation and benefits of home hospital care. Exploring these resources can offer a broader understanding of the Acute Hospital Care At Home program and its potential to transform healthcare delivery.
Conclusion: The Future of Acute Care is Evolving
The Acute Hospital Care At Home program represents a significant step forward in healthcare delivery. By leveraging technology and innovative care models, it aims to provide hospital-level care in a setting that is often more comfortable and conducive to healing – the patient’s home. As the program evolves and more data becomes available, it holds the potential to reshape how acute care is delivered, improving patient experience and optimizing healthcare resource utilization. For patients, providers, and healthcare systems, understanding the intricacies of the Acute Hospital Care At Home program is crucial for navigating the changing landscape of modern healthcare.
