Hospital-at-home at a crossroads: Navigating policy reversals and patient needs
The rapid expansion of acute care delivery beyond hospital walls is facing a major regulatory headwind. The Centers for Medicare & Medicaid Services’ (CMS) Acute Hospital Care at Home (AHCAH) waiver—a crucial COVID-19 era funding mechanism—expired amid the current Congressional gridlock.
Health systems that embraced this paradigm shift of care that can be delivered at home must now deal with the uncertainty in real time, with reimbursement being slashed to zero as the clock turned over on October 1.
What began as a pilot program in 1995, and with the 2020 pandemic acting as a catalyst, the AHCAH program grew rapidly to 384 hospitals across 140 different health systems in 39 states. Programs demonstrated viability by serving complex patients, including oncology and surgical populations, and successfully scaling to both dense urban areas as well as traditionally underserved rural regions. Some health systems have achieved as high as 30% cost savings for certain services by shifting the site of care to a home setting versus in a hospital.
The takeaway
Failure to extend funding for the AHCAH program poses potential challenges for health care systems. Organizations should weigh the costs of reverting to pre-pilot practices, or alternatively, explore strategic partnerships with managed care providers and private payers to sustain home-based care delivery outside of federal waivers. In addition, providers may want to pursue state-administered funding opportunities such as the Rural Health Transformation program, which offers formula-based awards to support innovative care models in underserved regions.
While the expiration of the AHCAH waiver presents immediate financial and operational hurdles, it also underscores a deeper commitment across health systems to reimagine care delivery.
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