Article
Bipartisan Support for Telehealth and Hospital-at-Home Initiatives
On March 15, President Trump signed the continuing resolution passed by Congress, which extended COVID-19-era Centers for Medicare and Medicaid Services regulations applicable to telehealth and hospital-at-home through September 30, 2025.
Uncertainty and Limited Planning Efforts
It’s only the most recent of several months-long extensions. Healthcare organizations simultaneously breathed a sigh of relief and continued to be frustrated that their ability to plan for the future was limited once again.
Telehealth and Hospital-at-Home Flexibilities
For telehealth, the CR extended flexibilities that remove geographic boundaries and expand telehealth service originating locations (including patients’ homes), permit more providers and services to be eligible for telehealth reimbursement, allow for audio-only visits, remove requirements for an initial in-person visit for behavioral health, and extend telehealth services for Federally Qualified Health Centers and Rural Health Clinics.
The extension of the hospital-at-home waiver, formally known as the Acute Hospital Care at Home initiative, or AHCAH, enables full Diagnosis Related Group-based reimbursement for Medicare patients who are provided hospital-level care in their homes.
Bipartisan Support
While the waiver extensions for both telehealth and hospital-at-home have bipartisan support, healthcare executives are deeply concerned the tangible benefits of each initiative will be lost, or not fully realized, if a long-term solution is not codified and executives are further stymied in their planning efforts.
Right-Sizing the Approach
As a result, a lot of this initial investment and commitment was haphazard and "side-of-desk" work; however, many systems have seen the potential for hospital-at-home and are taking the opportunity to right-size the approach.
Organizational Culture an Impediment
Finally, the biggest obstacle health systems face is organizational culture.
Conclusion
The hospital-at-home "movement" is at an inflection point. The data supporting the viability of the model is highly favorable, and it is real. While academic studies should continue to study the use case and its many facets, research supports a more mainstreamed approach that is not a series of pilot programs.
Program Refinements
In addition, as with any new or existing care model, there will always be required program refinements.
Logistics Management Remains a Significant Challenge
Logistics management remains a significant challenge, and many of the largest hospital-at-home programs still struggle here.
Operational Questions Remain Open
For instance, the original CMS waiver requires all hospital-at-home patients be admitted via the emergency department or transferred from the hospital floor. In many situations, the former is an extra logistical step, it’s not patient friendly, and a broader patient population may benefit if they could be directly admitted from other locations, such as urgent care, or via their primary care doctor.
Frequently Asked Questions
Q: What are the telehealth flexibilities extended by the CR?
A: The CR extended flexibilities that remove geographic boundaries and expand telehealth service originating locations (including patients’ homes), permit more providers and services to be eligible for telehealth reimbursement, allow for audio-only visits, remove requirements for an initial in-person visit for behavioral health, and extend telehealth services for Federally Qualified Health Centers and Rural Health Clinics.
Q: What is the hospital-at-home waiver?
A: The hospital-at-home waiver, formally known as the Acute Hospital Care at Home initiative, or AHCAH, enables full Diagnosis Related Group-based reimbursement for Medicare patients who are provided hospital-level care in their homes.
Q: What is the biggest obstacle health systems face?
A: The biggest obstacle health systems face is organizational culture.
Q: What is the next step for healthcare executives?
A: The next step for healthcare executives is to right-size the approach, build trust in the program through constant communication and education, and take a nimble approach that constantly evaluates successes and failures through a rapid and transparent appraisal process.
