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Blog: Lessons from CMS’ Acute Hospital Care at Home Initiative

Today CMS published a blog entitled “Lessons from CMS’ Acute Hospital Care at Home Initiative”. This email includes an abridged portion of the blog. For more details, including quantitative and qualitative data analysis, please visit the full blog here [ https://www.cms.gov/blog/lessons-cms-acute-hospital-care-home-initiative ].

*Lessons from CMS’ Acute Hospital Care at Home Initiative*

Dora L. Hughes, MD, MPH, Ashby J. Wolfe, MD, MPP, MPH, Danielle N. Adams, RN, BSN, MSN, and Jessica M. Warren, RN, BSN, MA

The COVID-19 public health emergency (PHE) challenged hospital bed capacity severely limiting access to critical medical services in patients’ time of need. In response, the Centers for Medicare & Medicaid Services (CMS) collaborated with outside experts to develop what ultimately became the Acute Hospital Care at Home (AHCAH) initiative, which is set to expire on December 31, 2024, unless Congress takes action to extend it. After three years of implementation experience, early lessons on quality, cost, and care experiences have begun to inform the future of CMS’ program and related efforts in the field.

CMS launched the “Hospital Without Walls” initiative in March 2020, using authorities under section 1135 of the Social Security Act permits the Secretary of Health and Human Services to waive or modify certain facility standards during PHEs, such as the COVID-19 PHE.i

Building upon this initiative, CMS began the AHCAH initiative in November 2020, which allowed acute care hospitals that are paid under the inpatient prospective payment system to expand their delivery of inpatient care into patients’ homes.

The AHCAH initiative would have ended with the termination of the COVID-19 PHE. However, in December 2022, Congress passed the Consolidated Appropriations Act (CAA), 2023, which extended the AHCAH initiative through December 31, 2024.2F  The CAA, 2023, also required CMS to conduct a study to evaluate several aspects of the AHCAH initiative. The Report on the [ https://qualitynet.cms.gov/acute-hospital-care-at-home/reports ] Study of the AHCAH Initiative [ https://qualitynet.cms.gov/acute-hospital-care-at-home/reports ] was published on September 30, 2024, and describes early lessons on quality, patient experience, and cost of care. iv

The study used the best available quantitative and qualitative data to compare AHCAH patients and brick-and-mortar hospital inpatients served by 332 participating hospitals across 38 states from November 2020 through July 2024. Data analysis focused on patient inclusion criteria and demographics, clinical conditions treated, quality of care, cost and utilization of services, and experience of care.

Conclusion

The mission of the CMS Center for Clinical Standards and Quality (CCSQ) is to improve lives, health outcomes, and care experiences by advancing quality, safety, and equity. Early lessons from the AHCAH initiative suggest that providers can deliver safe, quality inpatient care in home settings for appropriately selected patients, aligned with and helping to advance CCSQ’s core mission.

With the AHCAH initiative set to expire on December 31, 2024, important questions remain, and CMS is exploring opportunities to answer these questions should the program be extended. One such opportunity pertains to the inclusion of additional measures of cost, including costs to individual hospitals, as well as additional measures of quality and utilization. A second opportunity relates to the homogeneity of the current AHCAH patient participants, CMS is considering ways to work with hospitals to diversify patient populations receiving care through AHCAH, particularly lower-income and rural populations.

The CMS AHCAH initiative was created in a time of crisis. CMS will continue to study and share findings regarding AHCAH outcomes and costs, which will be needed for program sustainability in the long term if this initiative is extended.

For more details, view the full blog here [ https://www.cms.gov/blog/lessons-cms-acute-hospital-care-home-initiative ].

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i 42 U.S. Code § 1320b–5 - Authority to waive requirements during national emergencies. Accessed June 25, 2024.

https://www.law.cornell.edu/uscode/text/42/1320b-5. [ https://www.law.cornell.edu/uscode/text/42/1320b-5 ]

ii 42 CFR 482.23(b) and (b)(1) of the SSA

iii Section 4140 of the Consolidated Appropriations Act, 2023 (CAA, 2023) (Public Law 117-328)

iv Report on the Study of the Acute Hospital Care at Home Initiative. September 30, 2024. https://qualitynet.cms.gov/acute-hospital-care-at-home/reports








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