The Mayo Clinic and Kaiser Permanente have formed a new coalition to push HHS and Congress to maintain their programs and investments in home care after the pandemic.
Hospitals across the country have spent heavily on delivering home-based emergency care to patients as COVID-19 tested the safety and ability of systems to continue to care for patients in their facilities. For example, Mayo and Kaiser invested $ 100 million in May in Medically Home, which partners with systems to deliver services such as emergency care and cancer treatment. Many other members of the new coalition also use the company, such as Adventist Health, ProMedica and UNC Health. Other systems have built their own programs.
Eventually, the public health emergency in the country that allowed CMS to create the Hospital Without Walls program will end and compensation for these services will end. This new sector has experienced explosive growth thanks to new payments that were previously largely restricted to certain populations.
The Advanced Care at Home Coalition will work to create a new Medicare and Medicaid Innovation Center model that will allow service providers to apply for long-term flexibility. But CMMI models usually take years to develop and implement, so they are also working on a bill that Congress could pass to expand Hospital Without Walls if the public health emergency is harshly ended.
“This will be a major disruption to providers,” said Mara McDermott, chief executive of the new coalition. “All this infrastructure has been created. But there is also a very strong component of patient care that stands in the way of destruction, and it would really be a shame to lose all this progress we made during the pandemic. ”
Health systems also collect information about how emergency home care programs have impacted changes in Medicare costs, patient experiences, quality outcomes, and health equity.
This data will be critical as home-based inpatient care programs challenge the logistics of their care. While there are studies showing that some of these programs did increase hospital throughput, it is unclear if the quality results will continue or if the programs need new measures of quality and safety.
Ann Tumlinson, CEO and founder of ATI Advisor, a long-term care consulting firm, said it is critical to ensure that there are no racial or socioeconomic factors affecting whether patients can receive inpatient care at home.
“I think this indicates that next year, when the public health emergency ends, there will be a big challenge for policymakers: they will have to make difficult decisions about which new treatments (such as a hospital at home or telemedicine) leave or abandon them, ”Tumlinson said. “The main challenge will be to develop new ongoing programs with financial incentives that prioritize value over volume.”
Another coalition called Moving Health Home, formed earlier this year, with Intermountain Healthcare and Ascension, as well as several home care companies, including Home Hospital Provider DispatchHealth and Comprehensive Home Services Provider Signify Health, which do much more broad agenda. … The group wants Medicare to pay for EMT services even if the patient is not admitted to the hospital, and is expanding a package model that serves as an alternative to being in a skilled nursing facility.
Tumlinson said it is imperative to have groups focused on answering questions about how programs work, but she cautioned that systems and policies still need to pay attention to hospitalization prevention and public health.
“There is no doubt that we need to reduce the use of inpatient care in hospitals,” Tamlinson said. “But is there a solution to simply switch the setting to this level of concern, or prevent it in the first place?”