The Future of Hospital-at-Home Care: Challenges, Opportunities, and Uncertainties
The Rising Popularity of Hospital-at-Home Care
The concept of providing hospital-at-home care has gained traction over the years, especially since the Centers for Medicare & Medicaid Services (CMS) began reimbursing for such services. This progressive trend reflects a paradigm shift in healthcare delivery, moving away from the traditional, facility-based model towards a more patient-centric approach that emphasizes in-home care.
Uncertainty Surrounding CMS Waiver Expiration
However, despite the growing popularity of hospital-at-home care, some health systems remain hesitant to fully embrace this model. One reason for this hesitancy is the uncertainty surrounding the expiration of the CMS waiver at the end of 2024. The waiver has been instrumental in facilitating the reimbursement for hospital-at-home care, but its impending expiration has left many providers in a state of uncertainty. According to Nancy Foster of the American Hospital Association, for many hospitals, the risks associated with this uncertainty may outweigh the benefits, making the adoption of this care model a potentially unviable option.
The Role of Commercial Payers
Similarly, commercial payers are also adopting a wait-and-see approach, holding off on making decisions about whether to reimburse for hospital-at-home care until the government makes its move. The outcome of this situation will undoubtedly have significant implications for the future of hospital-at-home care, with potential ripple effects across the broader healthcare landscape.
Anticipating a Positive Outcome
Despite the current uncertainties, leaders in the hospital-at-home field remain optimistic. They anticipate that Congress will either extend the reimbursement or make it permanent. Dr. Michael Maniaci of Mayo Clinic’s hospital-at-home program likened the trend to the genie being out of the box, suggesting that it may be difficult to reverse this shift towards home-based care.
2024 Medicare Payment Rates and the Role of Value-Based Purchasing
The 2024 home health Medicare payment rates, effective from January 1, 2024, offer a modest aggregated increase in payments of only 0.8%. However, the national expansion of the Medicare Value-Based Purchasing (VBP) demonstration project offers home health (HH) agencies an opportunity to improve Medicare payments. VBP performance measures will determine up to a 5% positive or negative adjustment to Medicare payments in 2025 and 2026. Therefore, the VBP offers a substantial opportunity to improve Medicare revenues by up to 5%, but agencies that fail to keep pace with peers or show improvement will face a reduction in payments.
Challenges and Strategies for Home Health Providers in 2024
Home health providers are gearing up for 2024 amid challenges such as fee for service Medicare cuts, Medicare Advantage penetration, and staffing woes. To succeed financially and deliver better outcomes, providers are focusing on value-based care. Some providers are also embracing different types of care, including primary care through partnerships. They believe that a top-down understanding of value-based care is non-negotiable.
Renewal of the Joint Commission’s Deeming Authority
The Joint Commission’s deeming authority for home infusion therapy was renewed by CMS, effective from Dec. 15, 2023, through Dec. 15, 2029. This renewal means that home infusion therapy suppliers must be accredited by an accrediting organization to obtain Medicare reimbursement for the nursing component of the service.
NAHC President Bill Dombi’s Industry Outlook for 2024
NAHC President Bill Dombi shared his industry outlook for 2024, highlighting several key issues that will shape the landscape. These include market consolidation, payment rate cuts, service area reductions, and hospital referral rejections. He also touched on the anticipated permanency of innovative initiatives such as the Choose Home legislation and the Hospital at Home demonstration program. Despite the challenges, there is a relentless pursuit of solutions, with efforts focusing on funding scholarships and career ladder opportunities, as well as advocating for support from the industry to address the challenges.