Hospital at Home (HaH) Program: CMS Report Summary
The Hospital at Home (HaH) program, designed to provide acute-level hospital care in a patient’s home, has shown mixed results since its inception. This initiative, particularly relevant during the COVID-19 pandemic, was driven by the need to relieve overburdened healthcare facilities. The U.S. Centers for Medicare & Medicaid Services (CMS) launched the Acute Hospital Care at Home (AHCAH) initiative in 2020, allowing hospitals to deliver inpatient-level care to patients at home. As the program has matured, various positive and challenging outcomes have emerged.
Pros of the Hospital at Home Program
1. Patient Satisfaction and Experience
According to data collected through CMS listening sessions, many patients expressed positive experiences with the HaH program. Patients felt comforted by receiving care in familiar surroundings, which reduced the anxiety often associated with hospital stays. Feedback from caregivers mirrored this sentiment, highlighting that at-home care allowed for better integration of family members into the care process. The qualitative evidence supports that patients prefer home-based care, which improves satisfaction levels.
2. Reduction in Hospital-Acquired Infections (HAIs)
One significant advantage of the HaH program is the reduced risk of hospital-acquired infections. Due to shared spaces and equipment, traditional hospital environments carry a higher risk of infections. Data from the CMS report suggests that HaH patients experienced lower rates of HAIs compared to those in brick-and-mortar settings. This is particularly beneficial for patients with weakened immune systems at higher risk of acquiring additional infections in a hospital setting.
3. Cost Efficiency
Preliminary analysis of Medicare spending showed that patients treated at home under the HaH initiative had significantly lower Medicare spending in the 30 days post-discharge compared to patients treated in hospitals. By avoiding the need for extended hospital stays and reducing the need for high-cost hospital services, HaH programs have the potential to generate significant cost savings for healthcare systems. Additionally, AHCAH episodes demonstrated shorter lengths of stay for some diagnostic categories.
4. Decreased Mortality Rates
According to CMS’s evaluation, patients treated under the HaH program generally had lower 30-day mortality rates than those treated in traditional hospital settings. This supports the idea that, for certain conditions, hospital-level care can be delivered effectively in the home setting without compromising patient outcomes.
Cons of the Hospital at Home Program
1. Challenges in Patient Selection
The success of the HaH program hinges heavily on selecting the right patients. Not all patients are suitable for home care, particularly those with complex conditions or unstable social environments. The CMS report identified that AHCAH patients were more likely to be White, urban residents who did not require Medicaid or low-income subsidies. This raises concerns about equitable access, as underserved populations may face barriers due to social and environmental factors, such as housing conditions that are not conducive to home-based care.
2. Higher Readmission Rates for Certain Conditions
While the program has shown promising outcomes for many patients, the data indicate that readmission rates were higher for some conditions compared to traditional hospital settings . This suggests that not all conditions are well-suited to the home care model, and for specific diagnoses, the risk of complications post-discharge may be higher when care is provided at home.
3. Longer Lengths of Stay for Certain Conditions
Despite the overall cost efficiency observed in many cases, the average length of stay for some conditions treated at home was slightly longer than for patients treated in hospitals. If not managed carefully, this extended care duration could offset some of the financial savings. Moreover, a more extended stay could burden home healthcare providers and caregivers.
4. Workforce and Infrastructure Challenges
Implementing a hospital-at-home program requires a substantial investment in technology, workforce training, and home adaptations. Hospitals must ensure they have the infrastructure to provide round-the-clock care, including the ability to respond rapidly in emergencies. Furthermore, delivering high-quality care at home involves coordinating remote care teams and home visits, which may stretch existing healthcare resources thin, especially in regions with high patient volumes.
Conclusion
The Hospital at Home initiative represents a promising shift in healthcare delivery, providing hospital-level care in a more comfortable, cost-effective patient environment. However, the success of this program depends on carefully selecting patients who are most likely to benefit, ensuring equitable access across diverse populations, and addressing infrastructure and workforce challenges. The HaH model presents a significant opportunity for healthcare executives to expand capacity and improve patient outcomes, but it requires thoughtful execution and continuous refinement. As the AHCAH program evolves, understanding these dynamics will be critical in scaling it effectively across more healthcare systems.
Here is the link to the full report