A factor that could worsen ED boarding

An overwhelming majority of emergency department physicians say they have experienced boarding times in their facilities exceeding 24 hours. While hospital-at-home programs have been shown to be a tool to ease the boarding crisis, experts worry the problem may worsen if CMS funds for the program run dry by the end of the year, NBC News reported Feb. 7. 

CMS created the Acute Hospital Care at Home program in 2020. More than 300 hospitals have since been approved to stand up the program, though it's unclear how many are regularly using or investing resources in it. 

"For many hospitals, it seems like it might not be worth it," amid uncertainties over CMS funding, Nancy Foster, vice president for quality and patient safety policy at the American Hospital Association, told NBC

CMS funding for hospital-at-home programs is set to run out by the end of the year unless Congress votes to extend it for two more years. Hospital officials told the news outlet that while some private payers have signed on to the program, the majority of the funding comes from CMS and some are concerned scaling back such programs could worsen overcrowding and boarding in emergency departments.

ED boarding — when patients awaiting admission are held in the emergency department due to a lack of available inpatient beds — has been a persistent challenge for hospitals. In 2022, the American Medical Association and American Nurses Association were among dozens of medical groups who sent a letter to the Biden administration, calling attention to how staffing shortages had pushed boarding to a "crisis point." Discharge delays due a lack of beds in nursing homes and other long term care facilities are a key factor driving boarding challenges. 

In December, HHS secretary Xavier Becerra wrote a letter saying it had tasked the Agency for Healthcare Research to convene a multistakeholder roundtable to "identify actionable next steps and novel opportunities" to combat overcrowding and boarding in emergency departments. Mr. Becerra said he anticipated the round table could be convened within six months. 

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