Q&A: Hospital at home programs reduce readmissions, provide other benefits

The COVID-19 pandemic prompted CMS to expand the availability of hospital at home programs, which offer patients acute care in a comfortable setting.

In March 2020, CMS announced the launch of the Hospitals Without Walls program, which gave hospitals regulatory flexibility to provide services to patients outside their own buildings — at hotels or dormitories, for example. Then, in November of last year, CMS expanded on that program by initiating the Acute Hospital Care At Home program, which allowed hospitals to treat eligible patients at home. As of May 7, CMS had approved 129 hospitals in 56 systems to offer hospital at home care, according to the CMS website.

Brigham and Women’s Hospital was one of the hospitals approved for the Acute Hospital Care at Home program on Nov. 25, according to CMS. Healio Primary Care spoke with David Michael Levine, MD, MPH, a practicing general internist and investigator, about home hospital care at Brigham and Women’s Hospital.

Healio Primary Care: How has the COVID-19 pandemic affected the home hospital program? Do you predict that any of these changes will remain in place in the long term?

Levine: The pandemic has affected home hospital programs variably across the country. Some have had to shut down while others have expanded. At Brigham, we were able to expand operations by using redeployed clinicians and were able to serve as a safe place for patients to get acute care. It is too early to predict if Medicare changes will remain in effect after the pandemic, although we certainly hope this will become a permanent fixture for Medicare beneficiaries.

Healio Primary Care: What staff, technologies or other factors are needed to make a home-based hospital program work? Could these needs limit availability of home-based hospital services in rural or other underserved areas?

Levine: We have worked hard to make portable and miniaturize the key acute care equipment, technologies and supplies necessary to deliver acute care in the home. We have also worked to train and retain an acute care home-based workforce. We always try to adopt the right sort of technologies that deliver the right sort of care in the home. I lead a research team at Brigham and Women's and Ariadne Labs that is specifically looking at the feasibility and efficacy of rural home hospital care.

Healio Primary Care: Can you discuss the benefits that patients have seen?

Levine: Our research studies have shown large decreases in 30 day readmission, equal or better quality and safety, and very high patient experience.

Healio Primary Care: Are there any risks to home-based hospital programs? How can these risks be mitigated?

Levine: The risks to receiving home hospital care are somewhat similar to receiving traditional hospital care, in that acutely ill patients may not respond to treatment. When at home, distance can potentially be a factor, although this can be mitigated through continuous monitoring of deterioration.

Healio Primary Care: When considering whether a patient would be a good fit for a home-based hospital program, how should physicians weigh the risks and benefits?

Levine: We and others have worked for years to establish inclusion and exclusion criteria for patients. We published these criteria for all to use in our recent study.

References:

• Ariadne Labs. Rural Home Hospital. https://www.ariadnelabs.org/areas-of-work/rural-home-hospital/. Accessed May 11, 2021.
• CMS. Acute hospital care at home resources. https://qualitynet.cms.gov/acute-hospital-care-at-home/resources. Accessed May 10, 2021.
• CMS. CMS Announces Comprehensive Strategy to Enhance Hospital Capacity Amid COVID-19 Surge. https://www.cms.gov/newsroom/press-releases/cms-announces-comprehensive-strategy-enhance-hospital-capacity-amid-covid-19-surge. Accessed May 10, 2021.
• Levine DM, et al. Ann Intern Med. 2020;doi:10.7326/M19-0600.