Imagine an elderly patient spending their time in and out of the hospital, forcing themselves into uncomfortable and unfamiliar environments. Now, imagine that same patient, but in the comforts of their own home, still receiving the vital treatments they need. Thanks to hospital-at-home programs, which modern technology strengthens with remote patient monitoring,

health information technology infrastructure, sensors, and electronic health records, such a transition outside hospital walls is possible and makes this revolutionary care a reality for our nation’s elderly patients. However, insufficient reimbursement rates for this visionary care restrict hospitals’ ability to provide tailored, person-centered care. Medicare must adequately reflect this value in their reimbursement rates to represent our nation’s value of this quality of life-enhancing care through the Hospital Inpatient Services Modernization Act (HISMA). 

While some home health agencies and senior living companies have launched their versions of home care, Hospital-at-Home reigns supreme regarding quality and continuity of care. Its program has reduced the cost of care by at least 30% while improving patient outcomes. Various clinical trials found that Hospital-at-Home provides a 20% reduction in mortality, a one-third reduction in hospital readmission rate, higher satisfaction rates, and lower costs for involved patients. The Johns Hopkins hospital-at-home care model is a shining example of the program’s success. The program treats elderly patients who prefer to stay at home for their safety while reducing costs by 32%, length of stay by one-third, and patient delirium by 15%. From providing diagnostic studies of medical statistics and assessing home living situations to offering vital treatments and services, the value of these programs is undeniable. Furthermore, these services lead to less low-value care, unnecessary laboratory orders, imaging studies, and consultations.

Before the pandemic, Medicare did not cover hospital-at-home care. However, due to the significant issues regarding COVID-19, the Center for Medicare and Medicaid Services implemented their Acute Hospital Care at Home initiative in November 2022 to allow certain Medicare-certified hospitals to treat patients at home with their inpatient level of care. This act waives specific standards due to the public health emergency under Section 1135 of the Social Security Act, including suspending waivers requiring 24/7 nursing services and immediate registered nurse care. As long as hospitals reported data assuring patient safety, hospital-at-home care could be reimbursed at the in-hospital-level rates. While the act still fails to cover transportation costs, this initiative enabled hospitals to provide vital care to vulnerable patients in their optimal settings. However, this initiative will conclude at the end of 2024. 

The urgency of this situation cannot be overstated. Congress must act to ensure its continuation and expand the act. Currently, only 40 health systems, 96 hospitals, and 26 states have Medicare-certified programs: more are vital. If this measure is discontinued, providers will be unable to provide this vital care.  Congress has drafted HISMA to extend the program until 2027 and expand the program’s network to include 320 hospitals from 133 health systems across 37 states. While this growth is a start, many healthcare industry professionals, including the American Hospital Association, call for more expansive protections and inclusions beyond the Act’s narrow time limit and a restricted group of certified providers. These experts state that providing a greater policy scope would enhance reimbursement stability and protect revenues to enable programs to invest in developing and continuing services for the most patients possible. This assurance is crucial given that large hospitals like Mass General Brighman want to transition 10% of their medical patients to strictly receiving home care. According to healthcare providers, medical professionals can transition up to 40% of the United States’ current professional care for elderly patients into the home setting. 

Hospital-at-Home is at the forefront of our pioneering healthcare industry. Such cost-effective and patient-centered care further achieves the Quintuple Aim. However, we must also have a reimbursement format that values this achievement. Therefore, Congress must expand and implement HISMA to enhance and protect reimbursement for this care. Our duty to patients, providers, and the overall healthcare system is to ensure that this program is the new cornerstone of modern American healthcare. With the current COVID-19 policy soon to expire, now is the time to ensure the continued presence of this vital evolution in healthcare delivery.