Since the 2020 global pandemic, Hospital at Home (HaH), a healthcare delivery model that provides hospital-level care in the comfort of a patient’s home, has revolutionized healthcare delivery. It allows patients to receive medical treatment, including nursing care, intravenous medications, and monitoring, that they would traditionally receive in a hospital. This approach has been shown to be effective for certain conditions and can lead to improved patient outcomes, increased patient satisfaction, and cost savings.
The Acute Hospital Care at Home (AHCAH) initiative, launched by the Centers for Medicare and Medicaid Services (CMS) in response to the COVID-19 public health emergency, has been extended through December 31, 2024. This extension includes waivers and flexibilities for physical environment requirements in the home, telehealth flexibilities, and the waiver that allows a hospital to provide routine services outside of the hospital. The program typically follows these steps:
1. Patient Evaluation and Screening: Patients are evaluated for HaH care either in the emergency department or after being admitted to the hospital. They must pass both medical and social screenings to ensure the program is safe and appropriate for them.
2. Admission and Care Planning: Once approved for the program, the care team meets to plan the patient’s medications, meals, and coordinate the delivery and setup of any specialized medical equipment.
3. Care Delivery: Patients receive a range of services at their homes, including 24/7 remote patient monitoring, daily in-person or virtual visits from a nurse or a paramedic, medication delivery, meal delivery, and access to specialty care and services if needed.
4. Ongoing Monitoring and Support: Patients have 24/7 phone access to the HaH care team should they have questions or concerns or if a new issue arises. The care team also conducts frequent in-person or virtual meetings with the patient to review or modify their care plan.
5. Discharge and Follow-up: When the patient is stable for discharge, they are transitioned back to the care of their primary care physician. The HaH team coordinates with the patient and their family to develop a follow-up plan as needed.
Key CMS Regulations:
However, with this innovative approach comes a set of regulatory requirements that medical professionals must be aware of. The Centers for Medicare & Medicaid Services (CMS) has established specific guidelines to ensure patient safety and quality of care within this model.
- Acute Condition at Home Program: This program allows eligible hospitals to provide acute care services in patients’ homes, under specific conditions. The patient’s condition must require inpatient admission but can be safely managed at home with appropriate medical oversight.
- Eligibility Criteria: Hospitals must meet certain criteria to participate, including having a dedicated team for home-based care, ensuring 24/7 physician and nursing availability, and utilizing remote patient monitoring technologies.
- Patient Selection: Strict patient selection guidelines are in place to ensure patient safety. Not all patients are suitable for home-based acute care; specific medical and social criteria must be met.
- Quality and Safety Standards: Participating hospitals must adhere to stringent quality and safety standards, including maintaining comprehensive medical records, conducting regular patient assessments, and ensuring timely communication with the patient’s primary care physician.
- Billing and Reimbursement: CMS has established distinct billing codes and reimbursement mechanisms for services provided under the Hospitals at Home program.
Implications for Medical Professionals:
- Expanded Scope of Practice: Medical professionals involved in Hospitals at Home programs may experience an expanded scope of practice, requiring additional training and skills in areas like telemedicine, remote patient monitoring, and home-based care coordination.
- Collaboration and Communication: Effective communication and collaboration among the multidisciplinary care team are essential to ensure seamless care transitions and optimal patient outcomes.
- Regulatory Compliance: Medical professionals must stay abreast of the latest CMS regulations and ensure adherence to all applicable guidelines to avoid potential compliance issues and ensure patient safety.
The Hospitals at Home trend offers a promising alternative to traditional inpatient care, but it’s vital for medical professionals to understand and comply with CMS regulations to provide safe, effective, and compliant care within this model.
Please note that this is a simplified overview of CMS regulations for “hospitals at home.” Medical professionals should thoroughly review all relevant CMS guidelines and policies for a complete understanding.