Hospitals that have adopted the Centers for Medicare and Medicaid’s (CMS) “hospital at home” program, which serves as an alternative to admission in brick-and-mortar facilities, are concentrated in large urban, nonprofit centers and academic hospitals, a study suggests. new research.
The findings are among the first to portray the landscape of hospitals participating in this rapidly growing model of care, said Dr. Hashem Zikry, a participant in the UCLA National Clinical Scholars Program and lead author of the paper, which will be published in peer-reviewed magazine JAM.
“If CMS’s goal is to continue expanding hospital-at-home hospitals, these findings suggest that different incentives or outreach may be necessary for smaller, rural, and non-teaching hospitals,” Zikry said.
Established in November 2020, the CMS program allows hospitals to provide care for acute medical illnesses to patients in their own homes instead of a traditional hospital admission.
“Imagine, for example, a 70-year-old person who needs treatment for pneumonia,” Zikry said. “Instead of being admitted to a traditional hospital, hospital at home allows this patient to get the same resources, such as antibiotics and vital signs monitoring, in her own home.” An initial motivation for promoting hospital at home was to reduce pressure on hospital capacity, a problem that was exposed and exacerbated by the Covid-19 pandemic. “Many hospitals are running at 100% capacity almost all the time,” Zikry said, “so anything that can free up beds and mitigate that capacity crisis is tremendously attractive to health systems.”
Initially scheduled to expire in December 2022, Congress extended the home hospitalization waiver program through the end of 2024 and recently introduced legislation to extend it for another five years. Early participants in the CMS program tended to be large, urban, nonprofit academic hospitals. In light of the current proposal to extend the waiver, Zikry and his co-authors were curious to see if participation continued to grow after the initial 2022 extension and if the characteristics of participating hospitals had changed over time.
The researchers conducted a cross-sectional analysis of short-term acute care hospitals in the United States and used the 2022 American Hospital Association Annual Survey to obtain data on hospital characteristics. They compared hospitals that applied for the exemption between November 2020 and December 2022 (pre-extension hospitals) and those that applied after (post-extension). Of approximately 3,000 hospitals included in the study, 299 were granted exemption, 249 of them before the extension and 50 after the extension.
The study found that adoption of the waiver remained concentrated among large, urban, nonprofit and academic hospitals. The characteristics of the post-expansion hospitals were similar to those of the pre-expansion hospitals, although the former were somewhat smaller and showed regional differences.
Among their findings:
- Geographically, 49 (98%) post-extension and 226 (91%) pre-extension hospitals were in metropolitan areas.
- Post-extension facilities were most frequently located in the Northeast (16 hospitals, for 31%) or Western US (10, for 20%), compared to 30 (12%) and 26 (10%) pre-extension hospitals, respectively. In the south, 19 (38%) were post-enlargement and 143 (57%) were pre-enlargement.
- Of the post-expansion facilities, 24 (48%) had between 100 and 299 beds and 20 (40%) had more than 300 beds, compared to 86 (35%) and 126 (51%) before the expansion, respectively.
- Nonprofits comprised 46 (92%) post-extension hospitals and 201 (81%) pre-extension hospitals.
- Among academic hospitals, 27 (54%) were minor teaching hospitals and 11 (22%) were major teaching hospitals after expansion, compared with 137 (55%) and 64 (26%) before expansion, respectively.
According to Zikry, this research has multiple implications. On the one hand, if CMS wants to expand the scope of the hospital at home, more work must be done to incorporate smaller, rural, non-teaching hospitals. The data is clear: these types of hospitals are not looking to create these programs on their own, potentially due to the resources involved in creating and maintaining their operation until they grow.
Additionally, additional research is needed to understand the practical implications and advantages and disadvantages of hospital at home.
“Resources are being poured into these programs across the country,” Zikry said, “but we still don’t have a comprehensive understanding of how the programs work on the ground.”
Many questions remain, he said: “Are family members of these patients acting as unpaid caregivers during these admissions? Could these patients perform the same in other care settings? Do patients really prefer to be at home? And health care systems? health are taking advantage of this?” program equitably?”
Co-authors of the study are Dr. David Schriger of UCLA and Dr. Austin Kilaru of the University of Pennsylvania.