Many Americans will lose access to vital health care services in a few short months unless Congress passes bipartisan legislation already introduced in both the House and Senate.
Co-sponsored by Sens. Tom Carper (D-Del.) and Tim Scott (R-S.C.) and Reps. Earl Blumenauer (D-Ore) and Brad Wenstrup (R-Ohio), the Hospital Inpatient Services Modernization Act extends waivers allowing patients with acute illnesses to receive hospital-level care at home. The waivers are set to expire at the end of the COVID-19 public health emergency, most recently extended to July 15. More than 100 health care organizations have urged lawmakers to pass the bill.
Since the waivers were put in place by the Centers for Medicare & Medicaid Services two years ago, more than 200 programs in 34 states have delivered high-quality, hospital-level care in the homes of patients with serious conditions like congestive heart failure, strokes, and pneumonia. Acute care at home has been lifesaving for non-COVID patients when inpatient beds were full. It is a safe and viable care option, giving patients more flexibility in how and where they are treated.
The legislation would allow clinicians to continue delivering at-home hospital care for at least two more years. That means patients who want or need to stay home can access the same specialized care using a mix of telehealth and in-person visits, with constant monitoring and individualized care plans that meet patients’ needs and preferences and minimize disruption to their family life. Unless Congress passes legislation to extend the waivers, people who could benefit from in-home acute hospital services will be denied this care.
Although health care systems have developed different approaches to the same concept, we’ve learned over the last two years that the technology and services to treat patients with in-home hospital-level care can lead to lower costs, better outcomes, and high patient satisfaction rates. Clinicians also learned that treating patients in their homes provides unique insights into their lives, which fosters better tailoring of care to specific patient needs. This invitation into the home helps clinicians deliver true patient-centered care, as they get an up-close, first-person look into a patient’s diet, medication regimen, and other factors affecting health status.
Several leading health care organizations view the waivers as an opportunity to increase the equity of care they deliver within their integrated systems. Many patients in acute-care-at-home programs live in underserved rural and urban communities or face transportation challenges that make a trip to the hospital less likely for the patient and their families. If Congress allows the waivers to expire, the most vulnerable among us would be again, disproportionately impacted.
Early data suggest patients are safer and achieve better outcomes with in-home hospital care. A recent New England Journal of Medicine study of 1,900 acute-care-at-home patients showed eight unexpected deaths, or 0.4 percent of patients, compared to the average inpatient mortality rate of 2 to 3 percent. The Mayo Clinic has found that the readmission of acute-care-at-home patients within 30 days of discharge is 50 percent lower than for those in its traditional brick-and-mortar practice. Finally, initial studies show in-home hospital care costs can be 20 to 40 percent lower than a brick-and-mortar hospital.
More studies are needed to fully understand the impact of in-home hospital care programs on quality and cost. Extending the waivers will give physicians, health systems, health services researchers, and policymakers the opportunity to further analyze these programs’ results to determine the future for this person-centered care model.
The movement from inpatient to in-home acute-level care started long before COVID-19, and the pandemic accelerated it. Congress should extend the acute care at home waivers to ensure these innovative and patient-centered programs continue for those who rely on them. Congress must capitalize on the bipartisan efforts of Sens. Carper and Scott and Reps. Blumenauer and Wenstrup and pass legislation extending acute-care-at-home waivers that allow these care innovations to continue.
Stephen Parodi is an infectious disease physician and health care executive.
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