Several health systems are relaunching hospital at home after Medicare reimbursement for the care model was restored with the deal to reopen the federal government.
More than half of hospital-at-home programs temporarily or permanently closed following the Oct. 1 government shutdown, when the CMS waiver to provide acute hospital care at home expired. Another 23% pivoted to ambulatory care at home, according to the Hospital at Home Users Group. Daily admissions dropped by 67%.
But even before President Donald Trump signed a new federal spending package Nov. 12, some of those organizations had been gearing up to once again treat hospital patients at home. An estimated 20% of health systems offered hospital at home before the government stoppage.
“The Cleveland Clinic has resumed offering hospital-at-home services for eligible patients at all five of our hospitals in the Florida region,” Richard Rothman, MD, chief medical operations officer of Cleveland Clinic Florida, told Becker’s on Nov. 13. “We restarted full operations this morning and have already admitted over 15 patients to their homes.”
Rochester, Minn.-based Mayo Clinic also recommenced acute care at home Nov. 13. After the CMS waiver expired, the health system had to discharge its hospital-at-home patients in Arizona, Florida and Wisconsin back to brick-and-mortar facilities or step them down to ambulatory care at home.
“Luckily we’ve been running our outpatient-based program with the same computer setup on Epic that our inpatient program runs, so not a lot of changes had to be made,” said Michael Maniaci, MD, chief clinical officer of advanced care at home for Mayo Clinic. “We just switched back to the procedures and protocols we did prior to the government shutdown.”
Somerville, Mass.-based Mass General Brigham intends to reopen its home hospital Nov. 14 and ramp up to a capacity of 70 patients within several days. Staff had already started identifying good candidates, with the hopes of admitting 12 to 15 patients a day.
But seven weeks without the care offering put a strain on the health system. “We saw days with the highest boarding numbers that we’ve seen in the last few years,” said Stephen Dorner, MD, chief clinical and innovation officer of Mass General Brigham Healthcare at Home. “During the shutdown, we saw issues with overall capacity and length of stay in that same vein. So it was extremely disruptive from an operational perspective, and then certainly to our team as well.”
Mass General Brigham hospital-at-home staffers had to switch to other roles, mostly on the administrative side, so are excited to get back to care delivery, Dr. Dorner said. But he worries about programs around the country that might not come back after the disruption.
Kansas City, Mo.-based Saint Luke’s Hospital in Your Home had to close Oct. 1 with the shutdown, and a health system spokesperson said there were no updates Nov. 13.
Newark, Del.-based ChristianaCare, which continued accepting commercially insured hospital-at-home patients during the shutdown, began to admit people with Medicare again on Nov. 13. “We are committed to continuing this innovative program because it improves patient outcomes, enhances satisfaction, and reduces the burden on traditional hospital infrastructure,” said Sarah Schenck, MD, executive director of ChristianaCare’s Center for Virtual Health.
Marlton, N.J.-based Virtua Health said it will reinstate acute hospital care at home Nov. 17 after nearly doubling the patient volume for its post-discharge program in October.
Worcester, Mass.-based UMass Memorial Health and Edison, N.J.-based Hackensack Meridian Health also intend to restart hospital at home Nov. 17.
“I wouldn’t say it has been an easy lift per se — weeks of planning, redeploying staff then redeploying the staff back to HAH, recommunicating back out to all our referring stakeholders — but I am hopeful that we will be able to spin up back to our prior baseline within a week,” said Constantinos “Taki” Michaelidis, MD, medical director of UMass Memorial Health Hospital at Home, which previously had an average daily census of 15 to 20 patients.
Despite the resumption of business, hospital-at-home leaders want a more permanent solution. The new federal spending agreement lasts only through Jan. 30, so another shutdown is a distinct possibility. The House Ways and Means Committee passed a five-year hospital-at-home extension in September.
“We do need Congress to provide an infusion of confidence in the model aligned with the scale of the very strong quality, safety and capacity wins that HAH generates, and we’re hopeful this will occur soon with a longer extension,” Dr. Michaelidis said.
