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Hackensack Meridian Health, based in Edison, New Jersey, has started a program called Hospital At Home at JFK University Medical Center, also in Edison. The program will provide acute care in a Medicare patient’s home, and the healthcare system anticipates that it will eventually be scalable to a larger patient population.
As healthcare continues to expand beyond the confines of hospitals, Hackensack believes the program will improve outcomes, improve patient satisfaction, and make care more affordable.
The program is created through a Medicare waiver that allows hospitals to provide acute care to Medicare patients at home. The network selects patients based on factors that include diagnoses that often result in frequent and costly readmissions to hospital: uncomplicated congestive heart failure (CHF), pneumonia, chronic obstructive pulmonary disease (COPD) and cellulitis.
Initially, the program will enroll a few patients per week and will provide a range of in-home services, including two nursing visits per day; delivery of medicines, including infusions; rehab visits as needed; and remote patient monitoring that includes heart rate, blood pressure, heart rate, weight, and temperature. Nutritious meals and home healthcare support can be provided as needed.
WHAT IS THE IMPACT
The program was launched during the COVID-19 pandemic to help hospitals struggling with bed capacity. In November 2020, the Centers for Medicare and Medicaid Services released a waiver called the Acute Hospital Care at Home Waiver, which allows hospitals to bill for acute care services patients receive at home.
Research has shown that the programs are at least as safe as inpatient care and, according to Hackensack, lead to improved clinical outcomes, greater patient satisfaction and reduced health care costs. Patients have indicated they want home care, particularly during the pandemic: According to a recent survey, 85% of adults say expanding Medicare coverage for home health care should be a high priority for the government.
Ultimately, the network plans to expand the program to other hospitals once the pilot proves successful. And Hackensack believes her hospital-at-home program can be significantly scaled to include patients who aren’t covered by Medicare.
Another long-term goal is to expand coverage in underserved communities where transportation may be an issue – part of a broader strategic priority to reduce inequality in care delivery.
THE BIGGER TREND
Hospital At Home is a name registered as a trademark by Johns Hopkins University in 2010.
Many hospitals have adopted their own model. The hospital-at-home program has been practiced in some form since at least 2002. The concept isn’t new, but like telemedicine, hospital-level services at home became a necessity for all healthcare systems as acute care beds were filled during the first surge of the COVID-19 pandemic.
During the COVID-19 public health emergency, CMS is providing home hospital acute care reimbursement and has a list of eligible DRGs. In general, these are diagnoses of a medical nature with less clarity and not post-surgical care.
Like telemedicine, CMS reimburses this care during the PHE. Once the public health emergency is over, CMS will evaluate these services going forward.
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