Health systems advocate for 5-year hospital-at-home extension

More than 140 healthcare organizations, including more than 50 health systems, have sent a letter to Congress urging inclusion of a five-year extension of the Acute Hospital Care at Home (AHCaH) waiver program in the upcoming September government funding package.

The letter emphasizes that the Hospital Inpatient Services Modernization Act, a bipartisan, bicameral bill, would provide the long-term certainty necessary to fully realize the benefits of hospital-at-home programs.

These programs, the organizations said, have proven to deliver high-quality, cost-effective and patient-centered care.

Over several years, the AHCaH waiver has enabled health systems across the country to deliver acute-level services safely in the home. The groups said that the model has demonstrated reduced hospital readmissions, improved patient satisfaction and lower overall costs.

But without Congressional action, the temporary waiver authority will expire, which could threaten patient access and halt innovation, according to the letter.

The groups are asking for a five-year extension, which they say would give providers the predictability they need to expand capacity, invest in technology and staff, and bring hospital-at-home options to more patients in both urban and rural communities.

“A long-term extension is critical – not just for health systems to plan, invest, and scale these programs – but for patients, caregivers, and families who rely on the comfort, safety, and personalized attention that hospital-at-home care provides,” said Krista Drobac, founder of Moving Health Home, which brought the various healthcare organizations together. “Moving Health Home and 140 organizations urge Congress to pass a five-year extension to assure patients are able continue accessing high-quality care at home.”

WHAT’S THE IMPACT

The AHCaH program will not lead to new costs, according to the letter, and will contribute to patient choice by giving them the option to receive care on their terms.

“The AHCaH program also has the rare combination of lower spending, shorter lengths of stay, high patient and caregiver satisfaction, and high quality,” the letter read. “It deploys innovative technology and a workforce eager to treat patients where they live.”

Another extension of the waiver, the groups said, effectively builds the bridge from demonstration to a more permanent model by giving certainty to hospitals that are holding out for more regulatory clarity. 

In seeking to highlight its efficacy, the groups cited a report to Congress from the Centers for Medicare and Medicaid Services suggesting AHCaH had lower mortality rates and readmissions, lower post-discharge spending and positive overall experiences from patients and providers.

At the same time, a study published in the Annals of Internal Medicine found that the mean cost was lower for hospital-at-home care ($5,081) than for acute hospital care ($7,480). And a study published in the Journal of the American Geriatrics Society found that a hospital-at-home program was almost $6,000 lower in costs for inpatients.

“A long-term extension in September would solidify the evidence base, and allow more seniors to have the option to experience care at home,” the letter read.

THE LARGER TREND

CMS’ report on AHCaH last year found patients who receive hospital care at home generally have lower mortality rates than their brick-and-mortar inpatient counterparts.

Acute Hospital Care at Home waivers went into effect during the COVID-19 public health emergency. The Consolidated Appropriations Act, 2023 extended the waivers and flexibilities until the end of this year.

The American Hospital Association supports the Hospital Inpatient Services Modernization Act.