Trends in Inpatient Care Delivery
By Scott Manson, Managing Director, Advisory Services
The coronavirus pandemic created a need to expand hospital capacity. As a result the Centers for Medicare and Medicaid Services (CMS) created programs to meet acute care needs and give some patients the choice to be treated at home. In addition, to meet the needs of skilled nursing patients and provide a choice for care at home, a bill has been introduced to expand skilled nursing facility care outside of the facility walls.
Under federal requirements, hospitals must provide services within their own buildings. In March of 2020, CMS created the Hospitals Without Walls program to allow hospitals to transfer patients to other places, including the patient’s home, while still receiving hospital payments under Medicare. The program allowed hospitals to take care of patients needing less intensive care outside of the hospital while preserving inpatient beds for COVID-19 patients.
As a follow-up, on November 25, 2020, CMS executed the Acute Hospital Care At Home program which provides eligible hospitals regulatory flexibility to treat some patients in their homes. CMS believes more than 60 acute conditions, such as asthma, congestive heart failure, pneumonia, and chronic obstructive pulmonary disease, can be treated at home with proper monitoring. Under this program, a registered nurse evaluates the patient daily, either in person or remotely, and the patient receives at least two in-person visits daily. Early industry research shows the program improves patient outcomes, enhances the patient experience, and reduces cost.
Nursing home operators may need to consider offering at-home services if a recently introduced bill becomes law. On July 29, 2021, Senate Bill 2562 was introduced to improve extended care services by providing Medicare beneficiaries an option for cost-effective, home-based extended care under the Medicare program. Known as the “Choose Home Care Act of 2021,” the bill provides for up to 100 days of home-based extended care services with coinsurance starting on day 21. The care would be provided by a home health agency and would also include meals and nutritional support. Home health agencies would be paid additional amounts ranging from $2,010 to $10,720 per 30-day episode for providing between two and 12 hours of additional care per day. The amount would be geographically adjusted and updated each year.
This program would provide a cost-saving, home-based alternative to a skilled nursing facility. Some industry experts think approximately one-third of nursing home admissions could switch from facility based to at home care if the bill becomes law. The bill and an identical companion bill, H.R. 5514, currently have bipartisan support.
Aging Americans’ changing desires, coupled with the effects of the pandemic, are creating unique opportunities for healthcare providers.
If you have any questions about these programs, please contact your Marcum advisor.