Acute Hospital Care at Home Archives

Maximize the 90 Day Acute Hospital Care at Home Extension

The 90-day extension of the Acute Hospital Care at Home (AHCAH) waiver provides hospitals with continued flexibility from the Centers for Medicare and Medicaid Services (CMS), allowing them to deliver certain types of acute care in patients’ homes rather than requiring admission to a traditional inpatient facility.

Originally introduced during the COVID-19 public health emergency (PHE), the AHCAH waiver was designed to help hospitals manage patient surges more effectively, utilizing telehealth and home-based care solutions. Under the waiver, hospitals can treat eligible patients at home with appropriate medical oversight, including remote monitoring and necessary therapeutic interventions, thereby extending hospital-level care beyond the traditional setting.

Key Implications of the 90-Day Extension for Health Systems

Continued Flexibility for Hospitals:

The 90-day extension provides health systems with additional time to integrate home-based care into their operational strategies. This enables hospitals to treat patients who require acute care but do not need full hospitalization, optimizing the use of hospital resources.

The extension also offers hospitals greater flexibility in managing patient volume and capacity, helping to prevent strain on physical facilities—particularly in the face of potential patient surges.

Financial Impact:

Reimbursement and funding: The waiver enables hospitals to receive reimbursement for acute care provided at home, as though the care were delivered in an inpatient setting. These reimbursement rates may be subject to adjustment or extension as policies evolve.

Hospitals can continue billing Medicare for home-based acute care services, which represents a critical revenue stream. If this flexibility is extended or made permanent beyond the 90-day period, it could offer significant financial relief, particularly for hospitals in rural or underserved areas facing resource constraints.

Operational Adjustments:

Health systems may need to invest in infrastructure like telehealth systems, remote patient monitoring technologies, and home health nurse services to comply with the AHCAH requirements.

For hospitals not already equipped for home-based acute care, the extension provides an opportunity to ramp up resources or partner with home health solution providers.

Patient-Centered Care:

The extension allows hospitals to continue to offer patient-centered care by providing more comfortable care options for patients who are appropriate for home care, reducing the risk of hospital-acquired infections and improving patient satisfaction.

Quality of Care and Regulatory Compliance:

Hospitals will need to continue ensuring that the care provided at home meets the necessary clinical standards. Compliance with all applicable regulations and quality of care measures will be crucial to maintain eligibility for reimbursement.

Monitoring and quality assurance processes will remain key, as patients receiving care at home will still require oversight by healthcare providers to ensure their safety and well-being.

Strategic Planning:

Health systems might use the 90-day extension to evaluate the feasibility of incorporating hospital-at-home models into their long-term strategies. For some systems, the waiver could help them test these models on a larger scale to understand the financial, operational, and clinical implications before committing to more permanent changes.

Next Steps

The 90-day extension of the AHCAH waiver provides health systems with a unique opportunity to expand and refine their home-based care services. Inbound Health can be a key partner in this process by offering a comprehensive, scalable solution for delivering acute hospital-level care at home, ensuring regulatory compliance, improving patient outcomes, and optimizing operational efficiency. Our expertise in hospital-at-home care helps health systems confidently navigate this new care model and maximize the benefits of the waiver extension.

Discover what healthcare systems can do during this 90-day period, key insights from Washington officials and staff, and how Inbound Health can support your health system.

Read and download the details below.

AHCAH Waiver Extension One Pager Download

Ryan Carmel

January 3, 2025

Blogs

90 day extension, Acute Hospital Care at Home, AHCAH, care at-home, CMS, congress, extension, solutions, waiver
Hospital-at-Home Saves Both Lives and Money, but Congress Must Act to Keep It Alive

When it comes to ongoing healthcare initiatives aimed at improving care outcomes, the Acute Hospital Care at Home (AHCAH) program exceeds expectations by also increasing patient comfort, lessening the burden on hospitals, and lowering spending.

While the AHCAH program was launched by the Centers for Medicare and Medicaid Services (CMS) in response to the COVID-19 pandemic and its overwhelm of hospitals, the improved outcomes and lower spending seen with the program have lasted even after the pandemic ended. Offering in-patient level care at home allows hospitals to care for more patients, decreases a backlog of filled beds, and lessens the need for unnecessary procedures and treatments resulting from delayed care. The AHCAH program has shown the benefits it offers to the healthcare system, but it will nevertheless expire if Congress does not act by the end of the year.

Extending the AHCAH Program

The AHCAH program has already been extended once; it was initially planned to last only through the pandemic’s emergency period, but the Consolidated Appropriations Act of 2023 extended AHCAH through December 31^st, 2024. Since the time of its expiration has arrived, Congress must once again act to keep in action this initiative that improves outcomes while also lowering healthcare costs, a win for patients and carers alike.

While the deadline is quickly approaching, its renewal is not entirely out of the question. The Telehealth Modernization Act of 2024, which has bipartisan support in the House and Senate, includes an extension of the AHCAH waiver through 2029 that is supported by the American Medical Association. The hospital-at-home waiver offers hospitals reimbursement for providing at-home care to their patients with Medicare and Medicaid. The waiver also removes the requirement that a nurse must be present 24/7.

The Impact of AHCAH’s Expiration or Extension

The AHCAH program is no small feat and has become a cornerstone of Medicare programs. There are over 350 approved hospitals across more than 130 health systems that implement this innovative form of care delivery, and the expiration of the AHCAH program could be detrimental to these systems that rely on providing care-at-home services.

All patients can benefit from AHCAH. Rather than overcrowd hospitals, sometimes to the point where patients receive emergency care in hallways because no rooms are available, patients can be moved to their homes to complete the remainder of their care. For the aging population, care at home offers the opportunity for them to age in place, something that three-quarters of those in the United States over the age of 50 desire.

Knowing the universal benefits of the AHCAH, the expiration of this model can hurt all patients, but especially those with dementia, social barriers, and physical/sensory disabilities—for these individuals, care at home can make all the difference in their comfort, adherence to treatment, and treatment success.

AHCAH also offers healthcare workers a glimpse into the lives of their patients, which offers greater insights that can further improve the care they’re capable of providing.

Additionally, care-at-home programs demonstrate their superiority when it comes to lowering spending while improving healthcare outcomes. A report by CMS found that the mortality rate for AHCAH was lower for all 25 Medicare Severity Diagnostic Related Groups (MS-DRGs) they analyzed and significantly lower for 11 of these 25 MS-DRGs. Spending is lower, as well, with care-at-home shown to have lower Medicare spending in the 30 days after treatment for more than half of the top 25 MS-DRGs.

An extension of the AHCAH initiative gives health systems time to implement a care-at-home program or continue improving and expanding those that are already in place. It allows these facilities to provide for patients who can and want to be treated at home, increasing the care capacity of hospitals without increasing the costs required to provide this care.

How Inbound Health Can Help

If the AHCAH program is extended, it will provide your healthcare system with a vital opportunity to bring the benefits of care-at-home to your patient population, and Inbound Health can help.

Inbound Health partners with health systems to build, launch, and operate acute and post-acute care at home programs, allowing you to take the guesswork out of the best way to bring to life a successful AHCAH program that improves outcomes and lowers spending.

When it comes to the AHCAH program, the ball may currently be in Congress’s court, but you don’t have to wait to learn more about how Inbound Health helps health systems.

References

Fact Sheet: Report on the Study of the Acute Hospital Care at Home Initiative | CMS. (2024, November). Cms.gov. https://www.cms.gov/newsroom/fact-sheets/fact-sheet-report-study-acute-hospital-care-home-initiative

H.R.7623 – 118th Congress (2023-2024): Telehealth Modernization Act of 2024. Congress.gov. https://www.congress.gov/bill/118th-congress/house-bill/7623

Hospital at home saves lives and money: CMS report. (2024). American Medical Association; https://www.ama-assn.org/delivering-care/population-care/hospital-home-saves-lives-and-money-cms-report

Davis, M. R. (2022). 77 Percent of Older Adults Want to Remain in Their Homes as They Age. AARP. https://doi.org/1062105/3752820195

Ryan Carmel

December 2, 2024

Blogs

acute care at home, Acute Hospital Care at Home, AHCAH, CMS, hospital at home, waiver
Medication Reconciliation Process Prevents Costly Errors
Problem:

The FDA receives more than 100,000 medication error reports per year. These errors can occur in hospitals, clinics, patient homes, or pharmacies (FDA, 2019).¹Research suggests the average hospitalized patient is subject to at least one medication error per day, and an estimated 40% of errors occur in handoffs during admission, transfer, and discharge of patients.^2,3 Of these, an estimated 20% result in preventable and costly utilization, such as hospitalizations and fatalities due to serious side effects.

Solution:

Inbound Health is committed to ensuring the accuracy and safety of medication management for patients in its at-home care programs through a comprehensive medication reconciliation process. The care team reviews discharge summaries and carefully sorts through all new, existing, and outdated medications to ensure that patients are taking only those necessary and at the correct times. The team also assists with medication refills, monitors for potential drug interactions, and collaborates with pharmacists when needed to address any concerns.

Over a 2.3-year period (01/01/2022-03/31/2024), Inbound Health achieved a medication reconciliation completion rate of over 95%, preventing the potential for costly and avoidable adverse events for thousands of patients in its post-acute care-at-home programs.

Patient Snapshot

A 73-year-old male patient was recently discharged from the hospital with a detailed discharge summary. The Community Paramedic team was tasked with reviewing this summary, conducting medication reconciliation, and ensuring proper medication management. During a thorough review, the Community Paramedic discovered that the patient had mistakenly included several discontinued medications, including some antihypertensives, in his weekly medication supply. Had this issue gone unnoticed, the patient might have faced a higher risk of hospital readmission due to potential medication errors.

The Community Paramedic team undertook a meticulous review of the patient’s medications, verifying each item in his pillbox. Medications not included in the prescribed care regimen were removed, a process that took approximately 45 minutes to an hour. The community paramedic documented the incident and the corrective actions taken. An adjustment was made to the patient’s Amiodarone dosage, which is critical for managing certain abnormal heart rhythms and ensuring patient safety.

An Inbound Health analyst was assigned to research the clinical outcomes associated with hypertension medications and identify potential safety issues arising from incorrect dosages of drugs like Hydralazine and Amiodarone. The team also ensured the patient received the correct medications and understood their use, which helped build trust with both the patient and his family.

The Community Paramedic team verified that the patient was sent home with the correct medications and that they were received as prescribed. They coordinated with the patient’s pharmacy to ensure timely access to medications and provided additional support, including managing other aspects of the patient’s care such as steroids for infections, insulin for high blood sugar related to steroid use, medications for lung conditions, and arranging for oxygen needs. The patient received a transport tank and later a concentrator for home use.

This case underscores the essential role of medication reconciliation in preventing potential readmissions and ensuring patient safety. The proactive approach of the Community Paramedic team in identifying and addressing medication discrepancies highlights the importance of thorough medication management and effective communication within the healthcare team.
Sources:
1. https://www.singlecare.com/blog/news/medication-errors-statistics/#:~:text=The%20U.S.%20spends%20more%20than,errors%20(NCBI%2C%202021).
2. Institute of Medicine. Preventing medication errors. Washington, DC: National Academies Press; 2006.
3. Rozich JD, Howard RJ, Justeson JM, et al. Patient safety standardization as a mechanism to improve safety in health care. Jt Comm J Qual Saf. 2004;30(1):5–14.
Kyle Marcy

November 20, 2024

Case Studies

Acute Hospital Care at Home, medication, medication management, reconciliation, skilled nursing at home
The CMS TEAM Model Could Transform How Hospitals Manage Post-Acute Care
The Centers for Medicare and Medicaid Services (CMS) has finalized the Transforming Episode Accountability Model (TEAM) a mandatory five-year bundled payment model that has the potential to transform how hospitals manage acute care.

Overview of the CMS Team Model

Under the CMS TEAM model, select hospitals would be responsible for coordinating a Medicare beneficiary’s care when they undergo certain surgical procedures, from the point when surgery is completed until 30 days after the patient is released from the hospital. The hospital will be responsible for all services and items provided during this episode of care.

Hospitals will bill Medicare as usual under the TEAM model, but they will be given target prices for specific episodes of care based on 3 years of baseline data adjusted for various factors, including episode complexity and region data. Hospitals will then be assessed based on (1) How their actual spending compares to the target price and (2) Their quality of care based on certain quality measures. The hospitals with spending that is lower than the target price, while still meeting quality standards, will receive a TEAM payment—those that spend more will owe a Medicare repayment.

There are four steps that CMS will follow when calculating the TEAM Model Reimbursement Amount:

1. Convert the quality measure performance into a usable score by comparing your hospital’s performance to the performance of other hospitals and applying volume weighting (based on the volume of episodes per hospital).

2. Calculate the hospital reconciliation amount, or the difference in dollar amount between the target price and actual spending.

3. Adjust the cost amount using the quality score.

4. Finalize the Net Payment Reconciliation Amount by applying stop-loss or stop-gain limits based on your hospital’s track (1, 2, or 3).

The TEAM model is being implemented in an effort to address the scattered and expensive care that Medicare beneficiaries often end up with from bouncing between different doctors and clinics, receiving unnecessary or repeat tests and fragmented care. By aligning financial incentives, CMS believes that an improvement in care coordination—and ultimately better health outcomes—will follow.

What the CMS TEAM Model Means for Healthcare Providers

The TEAM model is a 5-year program that goes into effect on January 1^st, 2026, and ends on December 31^st, 2030.

As of now, the TEAM model includes only five procedures:

1. Coronary Artery Bypass Graft

2. Major Bowel Procedure

3. Lower Extremity Joint Replacement

4. Spinal Fusion

5. Surgical Hip and Femur Fracture Treatment

These TEAM episodes have been chosen as the inaugural five because they represent high-expenditure and high-volume care.

As a part of TEAM, there are steps that hospitals must take in regard to reporting health equity. Starting in performance year 1 (2026), hospitals must screen for at least four of the five health-related social needs (HRSNs), reporting the aggregated screening data and screened-positive data of each HRSN domain for every beneficiary.

Hospitals must also submit a health equity plan to CMS. While this is a voluntary submission in the first year of TEAM, it is a requirement for each year after. Information that must be included in the plan consists of:
- How the hospital plans to identify health disparities
- How the hospital plans to identify its health equity goals and how these goals will be used to monitor and evaluate progress toward reducing the identified health disparities
- The hospital’s health equity plan intervention strategy.
- How health equity performance measures will be identified, what data sources will construct these measures, and what will be used to monitor and evaluate the measures.
Along with the health equity plan, hospitals must also submit demographic data—race, gender identity, ethnicity, language, sexual orientation, disability, and sex characteristics—for their patients. Similar to the health equity plan, this is a voluntary submission the first year, then mandatory following that.

Prepare for TEAM with Inbound Health

With the implementation of the TEAM model in 2026 defining a shift toward improving quality of care, healthcare institutions must focus on finding ways to improve their quality of care while keeping down healthcare costs. Inbound Health can help.

Inbound Health enables healthcare providers to launch, scale, and operate acute and post-acute care-at-home programs, which improves patient outcomes, lowers costs, and increases hospital capacity by opening up beds for the sickest patients. The result is a greater capacity to care for patients in a timely manner, intervening in their healthcare before their health can regress, lowering the number of costly procedures, and limiting hospital readmissions.

When it comes to improving patient care and reducing costs, acute and post-acute care models are critical for addressing a key aspect of the care episode: the 30-day post-procedure period. Learn how Inbound Health can help you prepare for the TEAM model.
Ryan Carmel

November 14, 2024

Blogs

Acute Hospital Care at Home, CMS TEAM Model, quality of care, recovery care at home
Why Do People Opt for Hospital-at-Home Services?

While the world of AI expands, there are more virtual opportunities than ever before—including healthcare options. The concept of receiving hospital-level care in the comfort of one’s own home is gaining traction for its convenience, comfort, and cost efficiency.

Hospital-at-home services are reshaping traditional hospitalization norms. But what exactly makes hospital-at-home services so appealing, and why are more people opting for this alternative?

The Appeal of Hospital at Home

Comfort and Familiarity

One of the primary reasons individuals opt for hospital-at-home services is the opportunity to receive care in familiar surroundings. Being in the comfort of one’s own home can alleviate stress and anxiety often associated with hospital stays, promoting a faster recovery process.

Personalized Care

Hospital-at-home services are tailored to meet the specific needs of each patient. From customized treatment plans to one-on-one attention from healthcare professionals, patients receive personalized care that addresses their unique medical requirements.

Greater Independence

Hospital-at-home empowers patients to maintain a sense of independence while receiving necessary medical attention. By staying at home, individuals can continue with their daily routines and activities, fostering a greater sense of autonomy and well-being.

Enhanced Safety and Convenience

Research has shown that patients recover faster and experience fewer complications when receiving care at home. With hospital-at-home services, patients can avoid unnecessary exposure to hospital-acquired infections and enjoy the convenience of receiving medical treatment without the hassle of hospital visits.

Understanding Hospital at Home Services

The hospital-at-home program is designed to provide comprehensive and compassionate care to patients in the comfort of their homes. Powered by AI-driven analytics and supported by a team of dedicated healthcare professionals, our program offers the following key components:

Identification and Enrollment

Using advanced analytics, we identify patients who qualify for hospital-at-home services based on their medical complexity and environmental suitability.

Setup and Episode of Care

Our clinicians visit patients at home to set up necessary equipment and technology, ensuring seamless connectivity to our virtual care team. Patients receive personalized care plans tailored to their needs, including in-person visits, virtual consultations, and 24/7 monitoring.

Ramp Down and Transition

When clinically appropriate, we work with care partners to facilitate a safe transition back into the healthcare system’s network. Follow-up visits and ongoing support ensure continuity of care beyond the acute episode.

Explore Your Options

As the demand for flexible and patient-centered healthcare solutions grows, hospital-at-home services are poised to become a cornerstone of modern healthcare delivery. Hospital-at-homes are committed to pioneering this transformative approach to care, offering patients the opportunity to experience hospital-level treatment in the comfort of their own homes.

Alana Caporale

October 1, 2024

Blogs

Acute Hospital Care at Home, benefits, hospital care at home, why
The Value of Hospital-at-Home Programs for Healthcare Systems and Payers

As healthcare evolves, hospital-at-home programs are quickly becoming a game changer for both healthcare systems and payers. These innovative programs provide acute and post-acute care directly in patients’ homes, offering several advantages beyond traditional hospital settings.

One major perk of hospital-at-home programs is their potential for significant cost savings. By moving care out of traditional hospital settings and into patients’ homes, these programs cut down on various inpatient-related costs. This includes reducing facility fees, overhead expenses, and eliminating unnecessary tests and procedures. The result? A more cost-effective model that saves insurance companies money and lowers out-of-pocket costs for patients.

Hospital-at-home programs also help reduce the risk of hospital readmissions. With continuous monitoring and follow-up care, providers can keep a close eye on patients’ conditions and catch potential issues before they become serious. This proactive approach prevents complications and ultimately leads to fewer readmissions. For payers, this means lower costs and better patient outcomes.

Patients often prefer receiving care in their own homes rather than in a hospital. This preference boosts patient satisfaction, which positively impacts payer organizations. Higher patient satisfaction means better member loyalty and can enhance the overall reputation of insurance companies. So, not only do these programs improve patient experiences, but they also help with member retention and attracting new clients.

Additionally, hospital-at-home programs play a significant role in population health management. By focusing on preventive and proactive care at home, these programs tackle the root causes of acute episodes, manage chronic conditions effectively, and encourage wellness and self-care. This approach aligns with the broader goals of modern healthcare systems, which aim to improve health outcomes on a population level. Hospital-at-home programs offer a strategic advantage for both patients and insurance providers. They provide substantial cost savings, reduce readmissions, enhance patient satisfaction, and support effective population health management. As the healthcare industry continues to advance, integrating these programs into care strategies will lead to better outcomes and more efficient use of resources, making them a crucial part of the future of healthcare.

Discover how Inbound Health benefits patients, healthcare systems, and payers.

Kyle Marcy

September 6, 2024

Blogs

Acute Hospital Care at Home, benefits, hospital at home, hospital care at home, value

Maximize the 90 Day Acute Hospital Care at Home Extension

Key Implications of the 90-Day Extension for Health Systems

Next Steps

Hospital-at-Home Saves Both Lives and Money, but Congress Must Act to Keep It Alive

Extending the AHCAH Program

The Impact of AHCAH’s Expiration or Extension

How Inbound Health Can Help

References

Medication Reconciliation Process Prevents Costly Errors

The CMS TEAM Model Could Transform How Hospitals Manage Post-Acute Care

Overview of the CMS Team Model

What the CMS TEAM Model Means for Healthcare Providers

Prepare for TEAM with Inbound Health

Why Do People Opt for Hospital-at-Home Services?

The Appeal of Hospital at Home

Comfort and Familiarity

Personalized Care

Greater Independence

Enhanced Safety and Convenience

Understanding Hospital at Home Services

Identification and Enrollment

Setup and Episode of Care

Ramp Down and Transition

Explore Your Options

The Value of Hospital-at-Home Programs for Healthcare Systems and Payers