Advancing Hospital at Home with an Extension to the Acute Hospital Care at Home Waiver

On December 31st, 2024, the Centers for Medicare and Medicaid Services (CMS) waiver for the Acute Hospital Care at Home program will expire. Extended at the end of 2022, the program has continued to show success, and now industry leaders, policymakers, patient advocates and other stakeholders are coming together in the months leading up to this expiration to consider what a viable path forward looks like. Do we extend the waiver permanently, and what parameters should be in place to ensure a safe and effective approach to high-acuity care delivery in the home??

We sat down with Contessa’s Vice President of Quality and Patient Safety, Caroline Rogers , to discuss these questions and what the road forward might look like.??

“There are so many big things that still haven’t been unpacked. If we were to keep this permanently, how are we accrediting and regulating it? So much still needs to be discovered and decided on,” she shared. However, “The conversation feels different now than it did two years ago,” she added, referring to the initial extension of the waiver following the expiration of the COVID-19 public health emergency.??

With an analysis of over 11,000 patients now available to CMS for review, Rogers notes that “It’s a much more intentional discussion, thinking about the long term.”?

Overall consensus among industry leaders is that an extension would allow time for those larger questions to be worked through, and there are several areas of focus to consider. This includes standards of care related to regulatory, staffing, payer and technology practices that must be decided upon as more information becomes available.??

It’s a nod to the fact that hospital-at-home programs have only just begun to truly expand and scale after the COVID-19 pandemic. While initial evidence shows that its story is a success story, now we face an opportunity to solidify that success.??

As it now stands, “Every program is tracking data,” Rogers explained. “They’re all tracking it likely a little bit differently, and there’s the opportunity to standardize so that we can confidently prove, across the board, the value of this.”?

Drilling down into standardized data will also aid hospital-at-home programs with deciding those broader standards of care — there is still ongoing opportunity for innovation in the space as notes are compared. For example, some organizations leverage community paramedicine to deliver care, a potential antidote to nursing shortages. In this case, it would be important to determine what kind of data is needed to show that it is a safe and beneficial choice.?

Another pressing concern is standardizing services that ensure equitable access to care for patients who may face limitations. As Rogers notes, “In Contessa’s hospital-at-home model, if a patient doesn't have Wi-Fi, we are able to bring in temporary resources. We can provide food, and we work to provide the caregiver support needed to manage the medical episode.”?

At the end of May, Congress took an initial step in continuing these questions with the introduction of the Hospital Inpatient Services Modernization Act, which, if passed, would extend reimbursement for hospital-at-home programs for another five years. This additional time represents a valuable opportunity to further evaluate data and processes, establish standards for care, and uncover even more possibilities for advancing hospital-level care in the home.?

One thing is clear: this modality of care remains the new frontier of healthcare and is a viable solution to challenges faced in the industry, such as increasing bed capacity, improving care outcomes, and positively impacting patient satisfaction scores.?

We’re looking forward to the conversations that will be generated in upcoming months as we close in on the waiver’s expiration and embrace the ongoing industry collaboration that will ensure a strong and scalable future for hospital at home, both now and in the future.?