In this twice-monthly newsletter, you will find policy developments, research, and updates on how health care organizations are striving to shift more health care delivery into the home – meeting patient needs where they are and expanding access to quality health care.
The Hospital Inpatient Services Modernization Act (S. 3792/H.R. 7053) would extend the Centers for Medicare and Medicaid Services (CMS) Acute Hospital Care at Home waiver for two years after the public health emergency. In our press release, Krista Drobac, the founder of MHH, states:
"Many seniors needing acute-level care, and their caregivers, have been able to receive services at home during the pandemic. Temporarily extending the AHCAH program will allow for additional data collection and inform lessons learned, as well as provide the necessary time for a legislative process to establish a permanent Acute Care at Home program for Medicare patients.”
Medicare Payment Advisory Commission (MedPAC): March 2022 Report to the Congress: Medicare Payment Policy (3/15) - In addition to evaluating and making recommendations on Medicare payment issues, MedPAC's report reviews recent changes to the home health payment system, specifically the impact of the Bipartisan Budget Act (BBA) of 2018's mandated changes to the home health payment system. MedPAC's assessment concluded that access to home health care is more than adequate in most areas and that Medicare payments are substantially in excess of costs. MedPAC's two main recommendations to Congress regarding home health agencies were:
For Calendar Year (CY) 2023, Congress should reduce the 2022 Medicare base payment rate for home health agencies by 5 percent.
Home health agencies should be required to report the telehealth services they provide to Medicare beneficiaries under the home health benefit.
Congress: Bicameral, Bipartisan Introduction of Bill to Extend Hospital at Home Waiver Program (3/10) - U.S. Senators Tim Scott (R-S.C.) and Tom Carper (D-Del.) introduced the Hospital Inpatient Services Modernization Act (S. 3792 / H.R. 7053), legislation that would extend waiver flexibilities from the Centers for Medicare & Medicaid Services (CMS) brought on by the pandemic to bring acute-level care directly to patients in their homes, helping to reduce costs and enhance patient experiences. Congressmen Earl Blumenauer (D-Ore.) and Brad Wenstrup, D.P.M., (R-Ohio) also introduced companion legislation in the House of Representatives. Press releases can be found here for Senators Scott and Carper and Congressmen Wenstrup.
Congress: $1.5 Trillion Omnibus Spending Bill Passed Congress and Signed into Law (3/10) - Congress passed, and President Biden signed into law, the Consolidated Appropriations Act, 2022 (H.R.2471), which includes all 12 of the Fiscal Year (FY) 2022 appropriations bills and supplemental funding to support Ukraine and manage the COVID-19 pandemic. The bill extends existing telehealth flexibilities for 151 days beyond the end of the public health emergency—approximately five months. These flexibilities include:
Waiving geographic and originating site restrictions;
Expanding the list of eligible practitioners;
Allowing audio-only telecommunications; and
Permitting telehealth as a face-to-face encounter prior to recertification of a patient’s eligibility for hospice care
These telehealth flexibilities are critical to enabling home-based care models. The bill also funds the Administration for Community Living (ACL) at $2.3 billion, including $399 million for Home and Community-based Supportive Services, an increase of $6 million above the FY 2021 enacted level. The bill does not address upcoming Medicare sequestration cuts, which are set to phase in this April. Bill text; HHS explanatory statement; Full Summary; HHS Summary; and HHS One-Pager.
Congress: Bipartisan, Bicameral Bill Introduced to Ensure Access to Prescription Digital Therapeutics (3/10) - The legislation, known as the Access to Prescription Digital Therapeutics Act of 2022, would expand Medicare coverage to include PDTs, which are software-based treatments designed to directly treat disease, tested for safety and efficacy in randomized clinical trials, evaluated by the U.S. Food and Drug Administration (FDA), and prescribed by health care providers. PDTs are designed and tested much like traditional prescription drugs but rather than swallowing a pill or taking an injection, patients receive cognitive therapy through software. Bill text can be found here.
Congress: Senators Tim Scott, Warnock introduce the Technology-Enabled Care in the Home (TECH) Act (3/10) - Senators Scott (R-S.C.) and Warnock (D-G.A.) introduced the TECH Act, which would recommend that the Center for Medicare and Medicaid Innovation test the effect of technology-enabled care interventions in the home to coordinate care over time and across settings, improve quality, and lower costs for certain Medicare Advantage beneficiaries, and for other purposes.
CMS: Center for Medicare Director Envisions Holistic Approach to Health Care (3/16) - During an interview with the Journal of the American Medicine Association, CMS Director of the Center for Medicare Meena Seshamani discussed clinician perspectives of Medicare, CMS's priorities and vision, moving pieces in Medicare, and health equity. Home-based care was one area discussed: Dr. Seshamani mentioned how an enhanced payment methodology for home dialysis technology could ensure access to care.
HHS OIG: Telehealth Was Critical for Providing Services to Medicare Beneficiaries During the First Year of the COVID-19 Pandemic, Including in the Home (3/15) - Over 28 million Medicare beneficiaries used telehealth during the first year of the pandemic. This was more than 2 in 5 Medicare beneficiaries. In total, beneficiaries used 88 times more telehealth services during the first year of the pandemic than they used in the prior year. services that can be provided via telehealth include office visits, behavioral health services, nursing home visits, and home visits, among others. Beneficiaries’ use of telehealth during the pandemic also demonstrates the long-term potential of telehealth to increase access to health care for beneficiaries.
HHS: Secretary Becerra and HHS Leaders Celebrate Administration’s Accomplishments in Building a Healthier America, Focus on Home- and Community-Based Services (3/11) - Secretary Xavier Becerra and leaders across the U.S. Department of Health and Human Services (HHS) released statements celebrating the one-year anniversary of President Joe Biden’s enactment of the American Rescue Plan (ARPA) on March 11, 2021. Administration for Community Living Principal Deputy Administrator Alison Barkoff emphasized the role that state aging services networks serve in helping seniors age in place, while CMS Administrator Chiquita Brooks-LaSure discussed how ARPA expanded home- and community-based care for seniors and people with disabilities.
Research and Polling
Journal of Clinical Microbiology: Flu@Home: the Comparative Accuracy of an At-Home Influenza Rapid Diagnostic Test Using a Prepositioned Test Kit, Mobile App, Mail-in Reference Sample, and Symptom-Based Testing Trigger (3/16) - At-home testing with rapid diagnostic tests (RDTs) for respiratory viruses could facilitate early diagnosis, guide patient care, and prevent transmission. Such RDTs are best used near the onset of illness when viral load is highest and clinical action will be most impactful, which may be achieved by at-home testing. This study evaluated the diagnostic accuracy of the QuickVue Influenza A+B RDT in an at-home setting. The results supported the concept of app-supported, prepositioned at-home RDT kits using symptom-based triggers, but further research is needed to determine ways to improve the accuracy and utility of home-based testing for influenza.
Chartis Group: The Race Toward Digital Transformation: 2022 Health System Survey (3/16) - The report identified top priorities for digital transformation: remote patient monitoring (78%), digitally enabled service center (74%), digital specialty care (71%), digital-first primary care (70%), digital front door (69%), and hospital at home (60%). In particular, planning for hospital at home has significantly increased from the group's previous survey nine months ago: 2 in 3 respondents to the 2021 survey said they had plans for hospital at home in the next 5 years. In 2022, 4 in 5 are planning for hospital at home programs.
Moody's Investor Service: Not-for-profit and for-profit hospitals – US: Pandemic accelerates shift from hospital-based care, crimping revenue and margins (3/15) - Pandemic-driven shifts in care trends threaten hospital margins as telehealth and fewer emergency room visits have further changed the way people access care. Even before COVID-19, hospital admission rates were generally flat, according to Moody’s; now, virtual care options and fewer visits to the emergency room have accelerated the shift away from inpatient care. Moody's projected that the use of at-home acute care services will continue to grow; as a result, specialty care hospitals will be better off than others going forward.
Commonwealth Fund: Primary Care in High-Income Countries: How the United States Compares (3/15) - In the United States, decades of underinvestment and a low provider supply, among other problems, have limited access to effective primary care. Key findings of the report include:
U.S. adults are the least likely to have a regular physician or place of care, or a longstanding relationship with a primary care provider.
Access to home visits or after-hours care is lowest in the U.S.
U.S. primary care providers are the most likely to screen for social service needs.
Half of U.S. primary care physicians report adequate coordination with specialists and hospitals — around the average for the 11 countries studied.
Below is a chart showing how the U.S compares to other countries in home visits by primary care providers.
Southern Gerontological Society: Skilled Nursing Facility Care at Home for Adults Discharged From the Hospital: A Pilot Randomized Controlled Trial (3/10) - The ability to deliver skilled nursing facility (SNF)-level care at home is unclear. The objective of this study was to demonstrate the feasibility of rehabilitation at home (RAH) via a pilot randomized controlled trial. The treatments included daily care from providers, while core technologies included remote PT, automated medication dispensing, and continuous monitoring. The primary outcome measured was episode cost. The RAH pilot compared favorably to traditional SNF, with trends toward lower cost, greater functional status improvement, and better patient experience. Further research is needed, but RAH could reimagine how post-acute care is delivered.
Innovate Kidney Care: Position Paper: Recommended Changes to Conditions for Coverage to Improve and Modernize Kidney Care (Winter 2022) - In this position paper, Innovate Kidney Care recommends modifications to the Medicare Conditions for Coverage (CfC) for ESRD facilities under the following themes that will expand patient access to kidney care at home and foster innovation:
Alleviating the Nursing Shortage via Multidisciplinary Care Teams: Maximize the ability of all care team members to support home dialysis patients, which in turn will allow healthcare professionals to foster more attention toward patient outcomes, empowerment and safety.
Promoting Competition and Patient Choice: Expand care options and patient access to home dialysis and self-dialysis by encouraging new providers and delivery models in kidney care and reducing consolidation.
Furthering Patient Centricity: Modernize regulations and guidance to keep pace with the innovations in home dialysis and telehealth for dialysis patients. Leverage telehealth to create more customized, patient-centered options for both training and support.
Health Affairs: The Hospice Paradox: How Medicare Fails Americans At The End Of Life (3/11) - The chasm between what patients want at the end of life and what most families can provide is regrettably common. A 2017 Kaiser Family Foundation study found that 70 percent of Americans hope to die at home; nevertheless, a 2019 New England Journal of Medicine study reported that 60 percent of patients still die in hospitals and nursing homes. The reason for this disconnect between what patients and families want at the end of life and what is possible cannot be attributed to one sole cause. Nonetheless, Medicare’s insufficient funding for in-home caregiving support for those receiving hospice makes dying at home unaffordable and impossible for far too many.
Moving Health Home Featured in the Washington Times
Krista Drobac, the founder of MHH, talks about home-based care and ways to break down regulatory and statutory barriers restricting patients from choosing care at home. "To make the pandemic the beginning of a movement rather than a blip of change, we need to break down regulatory and statutory barriers restricting patients from choosing care at home. State and federal policymakers will need to implement permanent flexibilities and programs that build on the lessons learned from the temporary waivers of the Public Health Emergency (PHE)."
Healthcare Dive: What's holding up hospital at home? (3/17) - Widespread adoption of acute-level care at home models has been hampered by physician reluctance, patchwork reimbursement, and concerns about higher costs. "Most healthcare organizations say moving care to the home is a strategic priority," Chris McCann, CEO of care-at-home tech platform Current Health, told Healthcare Dive on the sidelines of the HIMSS annual conference on Wednesday. "Fewer have done that."
Fierce Healthcare: Moody's: Shift away from inpatient care will continue to shrink hospital margins (3/17) - Moody's Investor Service predicts that rates of inpatient care will drop due to changing reimbursement models, advances in drugs and medical devices and growing investment in outpatient services. While some hospitals and health systems were already using at-home acute care models before the pandemic, many more will look to provide acute care services at patients’ homes. Moody's also noted that hospitals nationally are accelerating investments in outpatient services.
Healio: Staff assistance, improved technology are key for home dialysis to succeed (3/16) - Due to advances in home hemodialysis and peritoneal dialysis, qualified patients who are properly prepared and supported throughout home-based care can achieve greater quality of life at lower cost compared with conventional in-center hemodialysis (ICHD). Currently, staff-assisted home care is not possible for many patients with dialysis and their providers due to structural and economic barriers, but this must change. Home assistance can provide a buffer for patients who are initially too nervous to self-administer treatment, eventually giving them the confidence and familiarity needed to succeed in home-based therapy.
Healthcare Dive: Pandemic hastens shift away from hospital inpatient care, Moody's reports (3/16) - New research from Moody's Investor Service shows that the long-term shift from hospital-based care toward more treatment delivered in the home and ambulatory centers picked up pace during the COVID-19 pandemic due to a surge in telehealth use and a drop in emergency room visits. Additionally, an increasing number of providers are focused on expanding in-home acute care admissions. This shift is expected to continue to gain momentum, pressuring revenue growth and margins in the hospital sector.
Mobi Health News: Hospitals at home poised to save money, keep the patient in familiar environment (3/16) - Panelists at HIMSS22 discussed the benefits and challenges of implementing a hospital-at-home program. Increasingly, health systems are offering hospital-at-home services: according to a HIMSS white paper, in-home hospitalizations save between $5,000 and $7,000 per episode. CMS' Acute Hospital Care at Home waiver allows for CMS to reimburse the hospital-at-home service at in-patient rates, if patients meet certain criteria for admissions, under the Public Health Emergency.
Fierce Healthcare: HIMSS 2022: Health systems see virtual care companies as biggest competitive threat: report (3/16) - 11% of health systems report being in the implementation phase of their personalized care and digital transformation journeys, but many have identified specific priorities for digital transformation efforts: remote patient monitoring (78%), digitally enabled service center (74%), digital specialty care (71%), digital-first primary care (70%), digital front door (69%) and hospital at home (60%). Planning for hospital at home has also increased considerably since last year: one in three respondents to The Chartis Group's 2021 survey said they had no plans for hospital at home in the next five years. Just nine months later, only one in five still have no plans.
PR Newswire: Andor Health and Microsoft Partner to Extend Virtual Care to Include Hospital at Home (3/15) - ThinkAndor Virtual Patient Monitoring and Hospital at Home now connects to a variety of devices to track a patient's health status remotely. Clinicians can monitor a patient's health, and care managers can effectively manage large patient populations regardless of the severity of their chronic condition. The same platform can also unlock a variety of inpatient monitoring scenarios such as Virtual Rounding and Telesitting. Hospitals and health systems can deploy one comprehensive platform to monitor and intervene to provide the best medical care for patients while in the hospital or at home.
STAT News: Covid-19 and telehealth: Holding on to the gains of remote care (3/15) Despite the newness of telehealth for many people, a recent report from Moving Health Home found that 73% of adults said they were confident in the quality of clinical care they received in the home, and 66% said it should be a priority for the federal government to increase access to clinical care in the home.
Post and Courier: Hospital-at-Home programs may help some patients, but face roadblocks in SC (3/14) - Two health systems in South Carolina are trying to provide Hospital-at-Home programs past the pandemic. One has been turned down by South Carolina’s public health agency — while the other is still operating its program. “The licensure and certificate of need laws make clear that hospital services are provided at the hospital, not at a patient’s residence,” said Ron Aiken, director of media relations for the Department of Health and Environmental Control. While this program is on pause for now, the hospital system has gained support from Charleston County’s state legislative delegation, as 14 representatives signed a letter of support to Gov. Henry McMaster calling for a temporary waiver to immediately grant Roper ability to provide at-home care across the Charleston region.
Home Health Care News: Study Shows SNF-at-Home Care Feasible, Less Costly (3/14) - According to a study by researchers from Brigham and Women's Hospital, seniors who received skilled care at home – instead of at a skilled nursing facility (SNF) – could experience considerable benefits, including better patient experience and lower costs. According to the study’s findings, rehabilitation-at-home (RAH) as a substitute for traditional SNF care has “favorable signals in patient experience, functional status, cost and days at home.” The researchers concluded that following a similar trial on a larger scale, RAH could become the standard. Findings also showed the median cost of care for patients receiving RAH was $8,404, compared to $9,215 for the SNF residents.
Healio: Group asks CMS to allow manufacturers, non-nursing staff to provide home dialysis training (3/14) - Innovate Kidney Care (IKC) wants CMS to update regulations to allow dialysis machine manufacturers and non-nursing personnel to provide home dialysis training. Coalition members said the update is needed to give dialysis providers more flexibility in providing home dialysis training. Outset Medical and other IKC members who authored the position paper said much of the need for change is based on a “rapidly increasing” shortage of nurses.
Managed Healthcare Executive: 5 Trends to Watch in 2022 Healthcare Hiring (3/14) - The first trend listed is "More opportunities for home healthcare and telehealth positions". Home visits and telemedicine are being used to help manage chronic disease, a variety of issues facing the elderly population, mental health issues, and more. With this trend, Managed Healthcare Executive expects to see more of the responsibilities normally handled within a medical facility to now be managed by clinicians outside of the office and inside of the home, increasing the demand for these essential home healthcare positions.
Fierce Healthcare: SXSW 2022: Best Buy, Samsung placing big bets on home health care as more seniors want to age in place (3/13) - Data shows that most adults 50 and older (77%) want to remain in their homes for the long term. This opens up the potential to use technologies to help seniors age at home, and it's a business opportunity that isn't lost on technology company Samsung and retail giant Best Buy. In 2018, Best Buy shelled out $800 million cash for Great Call, a provider of connected health and personal emergency response services to the aging population, with more than 900,000 paying subscribers. The company also has partnerships with telehealth company TytoCare for its remote medical exam kit, in-home healthcare startup Workpath for in-home blood draws and ScriptDrop for medication delivery. Samsung wants to build an ecosystem of partners among digital health companies who can build applications for its wearables and devices.
Home Health Care News: Immigration Pathway Could Boost Home-Based Care Workforce (3/13) - Over 7 million more direct care workers will be needed by 2029 in the U.S., according to a 2021 report from PHI. At least 4.5 million of those will need to be home care workers, and potentially more given rising demand. While the share of non-U.S. born workers in home-based care has increased steadily since 1980, a visa program that had home health aide specifically mentioned as a qualified occupation was discontinued in 2009 and has since thwarted continued growth. If that pathway was reenacted, it would immediately help home-based care providers. Other short-term fixes include a mimicking of the Au Pair program, which allows immigrants to care for U.S. children. Instead of children, in this case, it would be seniors. Lisa Rometty, president of CVS Kidney Care, said this type of care management could raise the bar for quality care and make the healthcare system less reactionary.
Mobi Health News: How tech support can encourage in-home chronic condition management, senior care (3/11) - During a panel discussion at ViVE, panelists discussed the importance of set-up support and provider input when using technology for managing chronic conditions in the home. Managing chronic conditions in the home using remote monitoring, virtual care and other tools is an increasingly popular space in digital health.
AJMC: Contributor: Medicare Should Empower Patients With CKD to Choose Home-Based Health Therapy Options (3/12) - From telehealth to home health reform, many of our country’s most vulnerable patients have been able to rest, recover, and avoid the risk of COVID-19 transmission by receiving treatment in the comfort and safety of their living rooms. However, we must continue to build on these innovations in order to streamline care for one of America’s most vulnerable populations: patients with kidney disease. Continued medical innovation has led to a safe and effective oral treatment for renal anemia that can be taken at home rather than through IV infusion in a clinical setting. With the growing popularity of telemedicine, in-home laboratory testing, and home healthcare, it make sense to allow Americans with renal anemia to be treated safely in the comfort of their own homes.
Becker's Hospital Review: Hospital at home playbook: Lessons from Mayo Clinic, Michigan Medicine and Presbyterian Health (3/9) - Hospital-at-home programs are proliferating across the country, as more health systems partner with companies like Medically Home or create their own internal programs. Waiver flexibilities spurred by the pandemic have also made such programs more viable to hospitals. However, getting a program up and running is no easy feat. Becker's spoke to three health systems that have successfully launched hospital-at-home programs and agreed to share advice and insights on their efforts.
U.S. News: The Post-Pandemic Role of Virtual Care (3/9) - To that end, a group of providers that includes Intermountain Healthcare, Ascension and Amazon Care recently formed a coalition — called Moving Health Home — to advocate for policy changes to designate the home as a site of clinical care. Members argue that advances in medical record-sharing, remote monitoring technologies and digital therapeutics have made it possible to deliver even acute care in the home in many cases. Salt Lake City-based Intermountain, for example, treats patients at home with everything from heart failure to some types of cancer with a combination of technology and visits from an interdisciplinary caregiving team.
Home Health Care News: Key Barriers Could Limit Adoption of Home-Based Care Models (3/9) - Despite that positive movement in the home-based care market, a few key barriers could limit broader adoption and growth in the sector, experts caution. Some of those barriers include an uncertain regulatory environment in a post-COVID-19 world, overly restrictive requirements for hospital-at-home programs and significant variability in requirements for providers across state lines. That’s according to a recent report from Moving Health Home, a coalition of home-focused health care organizations.
In Touch Weekly: The Hottest Health Trends to Look Out for in 2022 (3/4) - The first trend listed is Healthcare in the Home. Offering the opportunity to treat and diagnose without the potential risk of spreading disease in person has not only helped more patients stay safe during the pandemic but has also increased access to healthcare for those who need it most. “This year, there will be a continued focus on ways that those from overlooked communities can get access to the care that they need,” says Juan Pablo Cappello, Co-founder and CEO of Nue Life. “The quicker and easier we can all get in touch with healthcare professionals, the better it will be for everyone. Tech is helping us to do that.”