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CMS launches new hospital-at-home program for acute care

Hospital Safety Insider, December 3, 2020

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The Acute Hospital Care At Home program will help health systems and hospitals manage inpatient beds during the coronavirus pandemic and beyond.

By Christopher Cheney

The Centers for Medicare and Medicaid Services (CMS) have launched a new program to expand the availability of hospital-at-home care across the country.

Hospital-at-home programs provide inpatient-level care to patients in their homes such as daily supervision by doctors or nurses in-person or virtually via telemedicine. Hospital-at-home programs provide a higher level of care than traditional home health services, which generally focus on skilled nursing and physical therapy.

In an announcement last week, CMS launched the Acute Hospital Care At Home program, which is designed initially to help health systems and hospitals to increase acute care bed capacity during the coronavirus pandemic, CMS Administrator Seema Verma said in the prepared statement.

"We're at a new level of crisis response with COVID-19 and CMS is leveraging the latest innovations and technology to help healthcare systems that are facing significant challenges to increase their capacity to make sure patients get the care they need. With new areas across the country experiencing significant challenges to the capacity of their healthcare systems, our job is to make sure that CMS regulations are not standing in the way of patient care for COVID-19 and beyond," Verma said.

As part of the Acute Hospital Care At Home program, CMS has established an online portal to expedite waivers of the Hospital Conditions of Participation statute. The statute includes several requirements for inpatient-level care, including the 24/7 availability of nursing services on the premises of a hospital-level care setting.

Through the Acute Hospital Care At Home program, Medicare beneficiaries can received home-based care for more than 60 acute medical conditions, including asthma, chronic obstructive pulmonary disease, congestive heart failure, and pneumonia.

As part of last week's CMS announcement, six healthcare organizations were designated as the first participants in the Acute Hospital Care At Home program:

• Brigham and Women's Hospital in Boston
   
• Huntsman Cancer Institute in Salt Lake City, Utah
   
• Massachusetts General Hospital in Boston
   
• Mount Sinai Health System in New York City
   
• Albuquerque, New Mexico-based Presbyterian Healthcare Services
   
• West Des Moines, Iowa-based UnityPoint Health

PROGRAM REQUIREMENTS

Several requirements were included in last week's Acute Hospital Care At Home program announcement:

• Participating healthcare organizations must conduct screening protocols before patients are admitted to a hospital-at-home program. The screening protocols must include assessments of medical and non-medical factors such as home utilities, physical barriers in the home, and domestic violence.
   
• Medicare beneficiaries can only be admitted to a hospital-at-home program from emergency departments and inpatient hospital beds.
   
• A physician must evaluate a patient in-person before hospital-at-home care begins.
   
• A registered nurse must evaluate every hospital-at-home patient daily, either in-person or virtually via telemedicine.
   
• Every hospital-at-home patient must receive two in-person visits daily, either by a registered nurse or by a mobile integrated health paramedic.
   
• Patients cannot be required to participate in a hospital-at-home program.

Christopher Cheney is the senior clinical care? editor at HealthLeaders.

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