Creating the appropriate policy environment for hospital-at-home programs

The COVID-19 public health emergency declaration paved the way for the Centers for Medicare and Medicaid Services to provide eligible hospitals with unprecedented regulatory flexibility to treat eligible patients in their homes. However, more than 2 years later, that same declaration poses problems for health care organizations looking to deliver hospital-level care in patient homes, said Stephen Parodi, MD, in a recent Home Health Care News article.

“Where I think there is a potential roadblock here is the PHE (public health emergency) and its potential extension,” said Dr. Parodi, executive vice president of The Permanente Federation and associate executive director for The Permanente Medical Group. “In some ways the extension of the public health emergency, potentially into 2023, gives us an ongoing extension of being able to work under the existing waiver. But it also continues to create uncertainty over whether we’re going to have continued stability beyond the ending of the public health emergency.”

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To create a more stable path for advanced care-at-home programs, Dr. Parodi and other health care executives have been supporting the proposed Hospital Inpatient Services Modernization Act. This act would extend the current Acute Care at Home waivers — which allowed for the expanded delivery of hospital-level care at home for Medicare beneficiaries during the COVID-19 pandemic — for two years beyond the end of the PHE. The proposed legislation would also create more reporting measures and guardrails for at-home programs.

“If Congress doesn’t think they need to pass anything because the PHE is going to be extended, the momentum to move this along, unfortunately, is hindered,” Dr. Parodi said. “It’s really important that we impress upon everyone that in order to get these programs off the ground, you need to have the stability of knowing that you’re going to have the regulatory framework to keep them in motion.”

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Kaiser Permanente’s advanced care-at-home program upholds the organization’s commitment to provide safe, high-quality care that is also accessible and equitable. The model has been used to deliver patient-centered care to more than 1,600 individuals since the start of the pandemic, and the organization has plans for the program’s future growth.

However, many of the health systems and hospitals that received approvals to participate in the waiver program have delayed building out their care-at-home programs until they know whether the programs will be allowed to continue after the public health emergency ends. The delays have slowed innovation and care delivery options for patients.

“We’ve got more than 240 programs in 36 states that have been approved to participate in this program, but some of them are waiting on the sidelines before they jump in,” Dr. Parodi said. “Because they want to know that there’s some certainty that in the next couple of years, they’re going to have that time to ramp and build those programs up.”

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