The Acute Hospital Care at Home (AHCAH) initiative was launched during the COVID-19 public health emergency to address rising waiting times in hospitals, improve the quality of care received by patients, and protect essential workers. The Consolidated Appropriations Act, 2023 (CAA, 2023) extended the waivers and flexibilities of the AHCAH until the end of 2024 with the requirement that the Centers for Medicare & Medicaid Services (CMS) conduct a study and analysis on the AHCAH initiative. On September 30th, 2024, CMS released the findings of this study comparing AHCAH with brick-and-mortar hospital inpatient programs; detailed below are the highlights of their findings.
Quality of Care
Beginning with quality of care, the CMS study found that mortality rate was lower for those receiving care under the AHCAH initiative compared to those who were treated for the same conditions in brick-and-mortar inpatient facilities. Additionally, hospital-acquired conditions (HACs) were less common in hospital at home individuals for all six types of HACs evaluated.
As for readmissions, AHCAH was slightly superior to brick-and-mortar facilities, with AHCAH having a significantly higher rate of readmissions for two MS-DRGs while inpatient facilities have a significantly higher rate for three MS-DRGs.
Costs
To compare the cost of utilization, the study focused on metrics such as length of stay per episode and Medicare spending within 30 days of hospital discharge. The study found that AHCAH inpatients had a length of stay that was slightly longer, but the average amount of Medicare spending in the 30 days following treatment was lower for each care episode.
Of note, the differences in patient selection criteria and clinical complexity prevent CMS from stating, with certainty, that AHCAH resulted in lower Medicare spending compared to inpatient care at a brick-and-mortar facility.
Of note, the differences in patient selection criteria and clinical complexity prevent CMS from stating, with certainty, that AHCAH resulted in lower Medicare spending compared to inpatient care at a brick-and-mortar facility.
Patient Experience
Through virtual listening sessions and anecdotal information, the study concluded that patients and caregivers alike had a positive experience with the care provided through the AHCAH initiative. Clinicians, as well, mirrored this positive feedback in regard to their ability to provide care services.
Future Considerations
CMS’s study highlights the need for more targeted measures of quality, cost, and utilization in order to better understand how AHCAH compares to brick-and-mortar inpatient care. However, the continuation of the AHCAH initiative beyond December 31st, 2024—when the CAA, 2023 expires—is contingent on Congressional action.
There are currently several bills in Congress that would extend the CMS waiver between 2 to 5 years. With the CMS study complete and its favorable results for the AHCAH released, we await news regarding the extension of the CMS waiver.
If you’re intrigued by the findings of the CMS study, learn how Inbound Health enables healthcare systems to launch, operate, and scale acute and post-acute care programs.
Reference
Fact Sheet: Report on the Study of the Acute Hospital Care at Home Initiative | CMS. (2024). Cms.gov. https://www.cms.gov/newsroom/fact-sheets/fact-sheet-report-study-acute-hospital-care-home-initiative
