Shane McMahon, a paramedic for a hospital-at-home program in Massachusetts, visited 91-year-old Stephanie Joseph at her home. Joseph, who has diabetes, preferred receiving care at home rather than in a traditional hospital setting, especially after an emergency room visit due to high blood sugar levels.
“She says she’s feeling better,” Joseph’s daughter, Ketline Edouard, translating for her mother, reported. “Way better, more comfortable when she’s home.”
Currently, there are 378 hospital-at-home programs across 39 states, a model that gained traction during the pandemic when federal waivers allowed Medicare and Medicaid to reimburse for hospital-level care in patients’ homes. While the waiver has been extended once, its current expiration date is set for December 31, 2024.
Congress unveiled a spending agreement this week that includes a five-year extension for the waiver, but political tensions could threaten this plan. Notably, high-profile figures have urged Congress to reconsider, leaving the future of the funding uncertain.
Hospital-at-home programs offer significantly more intensive care compared to traditional home health services, typically involving comprehensive daily visits from healthcare professionals and 24-hour virtual monitoring. This innovative approach enhances hospital capacity and patient comfort, as emphasized by Heather O’Sullivan, head of the program at Mass General Brigham.
Though concerns have been raised by the National Nurses United regarding the safety of providing care outside hospital settings, studies from the Centers for Medicare and Medicaid Services indicate that patients in hospital-at-home programs report lower mortality rates and higher satisfaction than those receiving care in conventional hospitals. Financial analyses also suggest that the costs are comparable, if not lower, than traditional hospitalization.
As the expiration date for the waiver approaches, medical directors like Dr. Constantinos Micaelidis from UMass Memorial Medical Center express concern about potential repercussions. “Without the waiver, we would see much higher rates of inpatient boarding and overwhelmed emergency departments, returning to the capacity crises reminiscent of the COVID-19 pandemic,” he warned.
The American Hospital Association is actively advocating for the waiver extension, underscoring the need for stability among programs currently in operation. “We’re pushing for a five-year extension to guarantee continuation and growth for these crucial services,” Rachel Jenkins, a representative of the Association, stated.
Representative Jim McGovern of Massachusetts hopes for the extension to be included in the final federal spending agreement, acknowledging the challenging political landscape. “We probably won’t know until the very last minute,” McGovern remarked, highlighting the urgency as the deadline draws near.
