{"id":235709,"date":"2024-06-24T09:40:59","date_gmt":"2024-06-24T09:40:59","guid":{"rendered":"https:\/\/michigandigitalnews.com\/index.php\/2024\/06\/24\/what-to-know-about-medicare-and-hospital-at-home-programs\/"},"modified":"2025-06-25T17:16:21","modified_gmt":"2025-06-25T17:16:21","slug":"what-to-know-about-medicare-and-hospital-at-home-programs","status":"publish","type":"post","link":"https:\/\/michigandigitalnews.com\/index.php\/2024\/06\/24\/what-to-know-about-medicare-and-hospital-at-home-programs\/","title":{"rendered":"What to know about Medicare and hospital at home programs"},"content":{"rendered":"

[ad_1]
\n
<\/p>\n

These days, when people with Medicare<\/a> get to the hospital, they\u2019re increasingly asked: Would you prefer using our hospital at home<\/a> program?<\/p>\n

\n

That can be an enticing option if you need acute care for any of 60 conditions like COPD, pneumonia, congestive heart failure and urinary tract infections but not for things requiring a brick-and-mortar medical center like surgery or an MRI.<\/p>\n

In 2019, people with Medicare had over 800,000 hospitalizations that could have qualified for hospital at home, according to the actuarial and consulting firm Milliman.<\/p>\n

The disruptions of hospital stays<\/strong><\/h2>\n

\u201cThere\u2019s lots of evidence that, on average, patients are more comfortable in the home,\u201d says Pamela Pelizzari, principal and senior healthcare consultant at Milliman. \u201cIf you\u2019ve ever been in the hospital, it\u2019s disruptive. It\u2019s not restful. You\u2019re getting disturbed constantly for lots of things. There\u2019s an infection risk that it makes sense to try and avoid.\u201d<\/p>\n

With hospital at home, \u201cwe try to make sure that patients get to sleep<\/a> at night at their usual sleeping hours, not wake them at weird times of day and organize the care so it allows for good rest,\u201d says Dr. Pippa Shulman, chief medical officer at Medically Home.\u00a0<\/p>\n

Data on the quality and usefulness of hospital at home is fairly sparse. But a few studies have shown that compared to brick-and-mortar hospital stays, the in-home service lowers mortality rates, fall risks<\/a> and the onset of delirium while helping patients avoid infections some get in hospitals.<\/p>\n

What patients and caregivers say about hospital at home<\/strong><\/h2>\n

Studies have also found high satisfaction rates from hospital-at-home patients and their caregivers<\/a>. For people with Medicare, the out-of-pocket cost for hospital at home is generally the same as for receiving similar care in a hospital.<\/p>\n

Increasingly, says Rami Karjian, the founder and CEO of Medically Home, hospital at home is \u201cbecoming the default standard to provide care for eligible patients, as opposed to an exception.\u201d<\/p>\n

Nancy Foster, vice president for quality and patient safety policy at the American Hospital Association, calls hospital at home \u201ca very effective, efficient way to care for patients.\u201d<\/p>\n

How hospital at home works<\/strong><\/h2>\n

Hospital at home typically lasts for four or five days and can be declined by patients who prefer hospital stays. It has three components: daily in-person visits from doctors, nurses and paramedics; daily virtual visits from physicians and nurses at the hospital at home\u2019s \u201ccommand center\u201d and Bluetooth-enabled remote monitoring from tablets and phones given to patients plus the personal emergency response devices they wear.<\/p>\n

Advances in technology have made hospital at home much easier to provide, says Michael Dowling, co-author of The Aging Revolution<\/em> and president and CEO of Northwell Health<\/a>.<\/p>\n

\u201cOur tech kit takes about 15 minutes to set up,\u201d says Medically Home\u2019s Shulman.<\/p>\n

Medical care provided by hospital at home can include IV antibiotics and infusions, EKGs, blood pressure<\/a> monitoring, x-rays, and respiratory or oxygen therapy.<\/p>\n

Typically, to qualify for hospital at home, people with Medicare need to first go to the hospital for an interview. If they\u2019re selected as candidates, they then decide whether to enroll or to stay in the hospital.<\/p>\n

Medicare and hospital at home<\/strong><\/h2>\n

Hospital at home has been offered in the United States, England, Australia and Israel for decades, but Medicare typically didn\u2019t cover it until the pandemic.<\/p>\n

In 2020, however, when people without the virus wanted to stay out of hospitals and hospitals needed space for those requiring treatment for it, the Centers for Medicare and Medicaid Services (CMS) began allowing reimbursement for Traditional Medicare and private insurers\u2019 Medicare Advantage plans.<\/p>\n

Subsequently, hospital at home took off. In 2021, 186 hospitals offered it. Currently, about 320 hospitals in 37 states do, from Johns Hopkins in Baltimore to Mount Sinai in New York City to Sanford Health<\/a> in Sioux Falls, S.D. to Presbyterian Healthcare Services in New Mexico.\u00a0\u00a0<\/p>\n

In 2022, Medicare\u2019s hospital-at-home waiver was extended by two years.<\/p>\n

\u201cThere\u2019s no greater patient-centered care than care delivered in an individual\u2019s home setting where they\u2019re often most comfortable with their own sleeping accommodations and clothing, in addition to having easy access to their loved ones and their pets, who are often important elements in the return to health,\u201d says Heather O\u2019Sullivan, president of Mass General Brigham<\/a> Hospital\u2019s Healthcare at Home and a geriatric nurse practitioner.<\/p>\n

Hospital at home fans and critics<\/strong><\/h2>\n

Today, hospital at home has its fans\u2014and its critics.<\/p>\n

Lisa Rother, an Oklahoma City nurse, recalls the experience of one older man who had hospital at home from Medically Home, where she\u2019s senior director of strategic marketing operations.<\/p>\n

\u201cHe had been in hospitals multiple times for an infection of his bones and was losing his fingers gradually,\u201d she says. \u201cHe wouldn\u2019t stay in the brick-and-mortar hospitals because he felt very uncomfortable there. So, we hospitalized him within his home, helping him complete his full medical treatment and antibiotics and keep his hand.\u201d<\/p>\n

Rother says after the patient\u2019s third or fourth day in the program, \u201che loved our nurses, he loved our physicians and completely changed his attitude.\u201d<\/p>\n

After all, she asked, \u201cWhat better outcome can you have than being able to keep your limb rather than having an amputation?\u201d<\/p>\n

The American Hospital Association and American Medical Association are huge proponents of hospital at home.<\/p>\n

But a 2023 report from the Emergency Care Research Institute said there hasn\u2019t been enough reliable data on hospital-at-home outcomes. \u201cNo systematic evidence exists that H@H services to the acutely ill yield better patient care or lower costs compared to the current hospital-based system,\u201d it said.<\/p>\n

The nurses who oppose hospital at home<\/strong><\/h2>\n

National Nurses United, the nation\u2019s largest union and professional association of registered nurses, strongly opposes hospital at home.<\/p>\n

The group calls it \u201cHome All Alone\u201d and \u201ca grave threat to patient care and safety\u201d that can \u201cdeprive people of professional, 24\/7 nursing care.\u201d<\/p>\n

\u201cDevices being deployed in patients\u2019 homes can malfunction and give erroneous readings,\u201d says Michelle Mahon, assistant director of nursing practices at National Nurses United. \u201cThere are also user curves. Imagine you\u2019re very sick, running a high fever, can barely see straight and now you\u2019re supposed to enter your own vital signs into an app or tool that maybe you can\u2019t even see properly?\u201d<\/p>\n

Hospital-at-home providers and proponents reject those fears.<\/p>\n

\u201cWe assume the patient and caregiver have no ability or knowledge\u201d regarding the hospital-at-home tech devices, says Shulman.<\/p>\n

Some critics, like National Nurses United, also worry about what could happen to hospital-at-home patients with medical emergencies.<\/p>\n

\u201cIn the hospital, we are able to respond to a patient\u2019s change of condition and recognize it before it becomes a crisis,\u201d says Mahon. \u201cOften, those changes are detected by skilled nurses before the data shows there\u2019s a problem, especially in elderly people. There might be subtle changes in the way they talk or in their cognition, glassy eyes or in the smell of their breath. We can respond within seconds.\u201d<\/p>\n

Shulman\u2019s response, from Medically Home: \u201cWe do a lot of readings with the virtual technology. If the teams get readings that don\u2019t make sense, we have protocols for repeating them. If that\u2019s not working, we deploy someone to the house to figure out what\u2019s going on and intervene early so we\u2019re not running into emergencies.\u201d<\/p>\n

Doctors are most apt to select patients for the hospital at home programs who are unlikely to have a sudden emergency \u201cthat would warrant an immediate crush of health care personnel descending,\u201d says Foster.<\/p>\n

Hospital-at-home programs often keep in contact with their patients for a month after their experience ends.<\/p>\n

\u201cWe are making sure that our care plan works and you transition back to your primary care physician or specialist,\u201d says Mark Prather, cofounder and executive chairman of the Dispatch Health hospital-at-home operator.<\/p>\n

The Medicare rules for hospital at home<\/strong><\/h2>\n

Each hospital at home program has its own technology and care system. But they all must adhere to these CMS rules for people on Medicare:<\/p>\n