Health systems have had to scramble to discharge or move their hospital-at-home patients as CMS reimbursement for the program lapsed with the federal government shutdown.
Healthcare organizations approved for the CMS waiver to provide acute hospital care at home had to discharge or transfer those Medicare beneficiaries to the hospital by midnight Oct. 1, sending many patients back to capacity-strained facilities.
Rochester, Minn.-based Mayo Clinic had to transition or return its roughly 30 hospital-at-home patients in Arizona, Florida and Wisconsin to brick-and-mortar facilities. The health system is now focusing on outpatient, high acuity hybrid care at home, including early discharge (after 48 hours), oncology, emergency department avoidance, postprocedure treatment, and urgent care.
“The process of discharging or moving inpatients back took a lot of planning and manual work to make sure patients were treated well and with safety,” said Michael Maniaci, MD, chief clinical officer of advanced care at home for Mayo Clinic. “Our Florida hospital is at 110% capacity, so we had nowhere to put these returns. Lots of people [are] working on this.”
Somerville, Mass.-based Mass General Brigham had to discharge its inpatient-level home care patients or return them to the hospital, as the state of Massachusetts requires even commercial payers to follow CMS guidelines.
“Fortunately, the steps we have taken over the last year have enabled us to pivot our operations to provide advanced care at home for patients after a hospital stay during this pause,” a health system spokesperson told Becker’s. “This framework enables us to support patients outside of the inpatient waiver while maintaining the structure we need to provide exceptional acute care in the home.”
Kansas City, Mo.-based Saint Luke’s Hospital In Your Home, which only contracts with Medicare, stopped admitting new patients Sept. 26 ahead of the possible government shutdown. The program whittled its census down to six people, who either had to be returned to a full-capacity hospital or left with a tablet for nonbillable outpatient care at home.
“We unfortunately had to stop admitting, discharge all of our patients and escalate our patients who were still with us on Sept. 30 back to the brick-and-mortar hospital, where the ED boarding has been more challenged,” said Constantinos “Taki” Michaelidis, MD, medical director of Worcester, Mass.-based UMass Memorial Health Hospital at Home, which had an average daily census of 15 to 20 patients.
“We are going to remain paused and closed for now while our staff work in other areas of the medical center to support our colleagues, although this is not — unfortunately — going to be creating new capacity like HAH does. We are very hopeful that Congress will act soon.”
Newark, Del.-based ChristianaCare has continued its hospital-at-home program for commercial insurance patients but had to remove its Medicare patients, even as the care model grows in popularity.
“Our [net promoter scores] are between 90 and 100, so just to put that in perspective, the iPhone is like 55,” said Sarah Schenck, MD, executive director of ChristianaCare’s Center for Virtual Health, Sept. 30 at Becker’s 10th Annual Health IT + Digital Health + RCM Conference. “So our patients absolutely love it.”
Hospital-at-home leaders hope Congress can come up with a longer-term solution — a five-year CMS waiver extension has also been proposed — even if an agreement is reached to reopen the government.
“Administrators don’t like uncertainty, especially when you have multiple FTEs and a million-dollar budget to support,” said Michael Nassif, MD, medical director of Saint Luke’s Hospital In Your Home, at the Becker’s conference.
“We have nine APPs (advanced practice providers), we have 16 nurses, and we have 20 field staff paramedics,” he said. “There are contingency plans for nurses to either take PTO or go into the float pool, and then practitioners have to go work in urgent care. So I just worry how this wears on the staff to do this multiple times and have this uncertainty multiple times.”
