As hospitals reconsider how and where they deliver care to patients, many are seeing the hospital-at-home model as a promising approach to improve value. Hospital-at-home enable some patients who need acute-level care to receive care in their homes, rather than in a hospital. This care delivery model has been shown to reduce costs, improve outcomes and enhance the patient experience.

In November 2020, the Centers for Medicare & Medicaid Services launched the Acute Hospital Care At Home program to provide hospitals expanded flexibility to care for patients in their homes.

On September 30, 2024, the Centers for Medicare & Medicaid Services (CMS) released a report on the agency’s study of the Acute Hospital Care at Home (AHCAH) initiative, which allows certain Medicare-certified hospitals to treat patients with inpatient-level care at home. While the initiative was launched during the COVID-19 public health emergency (PHE), the Consolidated Appropriations Act, 2023 (CAA, 2023) extended the waivers and flexibilities associated with the AHCAH initiative until December 31, 2024. The CAA, 2023 also required CMS to conduct a study and analysis on the AHCAH initiative and post such a report on a CMS website by September 30, 2024.

The new study fulfills the requirement in the CAA, 2023, and evaluates several aspects of the AHCAH initiative, including:

– – Criteria participating hospitals used to determine which individuals would qualify to receive services under AHCAH.
– – Demographic information on beneficiaries treated under the initiative.
– – Clinical conditions treated and diagnosis-related groups associated with discharges from the inpatient setting versus those under AHCAH.
– – Quality of patient care for those patients treated in the brick-and-mortar inpatient setting relative to patients with similar conditions and characteristics treated under AHCAH.
– – Beneficiary and caregiver experience with AHCAH.
– – Medicare spending and utilization for patients who received care in the inpatient setting and through AHCAH.
– – Quantity, mix, and intensity of services furnished through brick-and-mortar inpatient care relative to those served under the AHCAH initiative.

The study found that AHCAH-approved hospitals used a variety of sources and methods to establish patient selection criteria to determine which individuals would qualify for AHCAH services. These criteria were largely rooted in published hospital at home (HaH) literature, in addition to the individual hospital’s experience and resource capabilities to provide inpatient-level care in the home environment.

Participating hospitals indicated that these criteria were developed and utilized with the intent to ensure that eligible patients were willing and able to participate in a HaH program, that such patients were clinically and psychosocially appropriate to safely receive care in the home, and that patients’ home and community environments were conducive to the safe and effective provision of acute inpatient care at home.

CMS hosted a series of four virtual listening sessions with various groups of stakeholders, including patients and caregivers who had participated in the AHCAH initiative, to learn about their experiences with care and gather feedback on ways to improve the program. Additionally, CMS collected anecdotal information on shared lessons learned through site visits, direct correspondence with patients and hospital program operators, and other means, contributing to the qualitative analysis of beneficiaries’ experiences with the AHCAH initiative.

Overall, the information collected and detailed in the study suggests that patients and caregivers had positive experiences with the care provided in the home setting through the AHCAH initiative. The feedback was generally consistent with evidence concerning patient experience with HaH programs more broadly. This positive feedback was mirrored by clinicians’ experiences providing care to patients under the AHCAH initiative. More detailed findings on the patient experience of care under AHCAH and the interpretation and limitations of the underlying data and analysis are presented in the report.

The American Hospital Association has considerable information about providing HaH services for it’s members, as does the California Hospital Association.

CMS Reports Success With New Acute Hospital Care at Home (AHCAH)