Recent studies have unveiled a trend in the advent of “hospital-at-home” programs initiated by the Centers for Medicare and Medicaid Services (CMS).
This model, designed as an alternative to traditional hospital admissions, is predominantly embraced by larger urban hospitals, specifically those affiliated with not-for-profit organizations and academic settings.
Distribution of Hospital-at-Home Programs
Dr. Hashem Zikry, a key researcher from UCLA and lead author of an upcoming paper in JAMA, emphasizes the distribution of these innovative care models.
He indicates that for the CMS to broaden access to hospital-at-home services, there must be a reevaluation of the incentives and outreach strategies directed at smaller, rural, and non-teaching hospitals, which currently appear less engaged with this initiative.
The hospital-at-home program was officially launched in November 2020, granting hospitals the ability to offer acute medical care to patients within their own residences instead of conventional hospital stays.
For instance, a 70-year-old with pneumonia could receive vital treatment, including antibiotics and monitoring of vital signs, right at home, thus avoiding an in-hospital admission.
Research Findings on Hospital Participation
The push for hospital-at-home services gained momentum as the healthcare system faced increasing strain, especially during the COVID-19 pandemic when many facilities were operating at full capacity. Dr. Zikry notes that alternative care models, such as this one, not only help alleviate the burden on hospitals but also provide timely services for patients in need.
Initially, this waiver program was set to conclude in December 2022; however, Congress has extended it through the end of 2024, with proposals for an additional five-year extension on the table.
Researchers have taken a keen interest in whether participation levels in these programs will rise following the extension and whether the profile of participating hospitals will shift over time.
To delve into these questions, a cross-sectional analysis was performed examining short-term acute care hospitals across the United States, utilizing data drawn from the 2022 American Hospital Association Annual Survey.
Researchers differentiated between hospitals that applied for the waiver prior to the extension (between November 2020 and December 2022) and those that did so afterward.
Out of nearly 3,000 facilities assessed, 299 secured the waiver, with a sizable portion applying before the extension was enacted.
Implications for Future Outreach
The findings reveal a significant concentration of waiver adoption among large, urban, non-profit, and academic hospitals.
While the characteristics of hospitals that sought the waiver after the extension closely mirrored those of their earlier counterparts, some distinctions emerged, including differences in size and regional representation.
- A substantial share of hospitals requesting the waiver were located in metropolitan regions, with 98% of post-extension facilities and 91% of pre-extension facilities situated there.
- In terms of geographical spread, post-extension hospitals were primarily found in the northeast (31%) and western (20%) U.S., while their pre-extension equivalents comprised only 12% and 10% in those areas.
The southern U.S. saw a notable presence of post-extension hospitals at 38%, compared to 57% for the pre-extension group.
- In examining hospital size, it was found that 48% of post-extension institutions had 100 to 299 beds, with 40% boasting over 300 beds.
In contrast, pre-extension figures showed only 35% in the smaller category and 51% in the larger.
- Among post-extension waivers, non-profit hospitals accounted for 92% of the total, a jump from 81% in the prior group.
- In terms of academic participation, post-extension hospitals had a higher proportion of smaller teaching institutions (54%) compared to major teaching hospitals (22%).
This contrasts with pre-extension figures of 55% and 26%, respectively.
Dr. Zikry underscores the implications of these observations, pointing out that for CMS to effectively expand hospital-at-home programs, outreach must be enhanced towards smaller, rural, and non-teaching hospitals, which face significant barriers in launching such initiatives due to capacity and resource limitations.
He also advocates for further exploration into the practicalities and potential limitations of hospital-at-home care.
Questions linger about the involvement of family members as caregivers, the comparability of care in different settings, patient preferences regarding home care, and the equitable distribution of these services across various health systems.
This research was also supported by contributions from Dr. David Schriger at UCLA and Dr. Austin Kilaru from the University of Pennsylvania.
Source: ScienceDaily