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Key takeaways:
With recent COVID-19 flexibilities as a springboard, hospitals, health systems and providers across the care continuum have embraced and advanced a home care approach and have tailored programs to meet specific patient and organizational objectives.
This newer avenue of care treat patients in the comfort of their home rather than admitting them to the hospital - and can free up hospital capacity, offer a safe and effective method to appropriately care for certain patients, and unlock the potential for reduced costs and improved outcomes.
Alongside consumer preferences for receiving at-home care, recent studies show this approach is leading to lower rates of mortality and readmissions. Additionally, at-home care can cost up to 38 percent less than care furnished in a facility.[1]
That’s why Premier is advocating for the following in three key areas:
In response to a desire to provide better care, reduce readmissions and lower costs, Premier member Mount Sinai Health System explored how to provide care in patients’ homes when appropriate. The health system found patients participating in its hospital-at-home program had:
During the COVID-19 Public Health Emergency (PHE), concerns around acute hospital capacity and patient safety prompted many commercial payers and Medicare to remove restrictions and allow for payment of hospital-at-home services under certain circumstances.
The Acute Hospital Care at Home (AHCAH) program enables providers to effectively monitor and provide at-home care for patients, including remote monitoring capabilities, in-home provider visits, telehealth, medication management, and other care strategies.
Under the program, hospitals can request a waiver of the Medicare Hospital Conditions of Participations (CoPs)[2], requiring nursing services to be provided on premises 24 hours a day and that a registered nurse be immediately available for patient care. Participating hospitals must furnish at least two in-person visits daily and meet certain minimum emergency response times, such as allowing for immediate connection to on-demand virtual care or in-home care within 30 minutes, if needed.
As of July 2022, 110 health systems operating 245 hospitals across 36 states were participating[3] – but the Medicare Hospital-at-Home program will end when the PHE expires unless the Centers for Medicare and Medicaid Services (CMS) acts.
With the long-term care (LTC) population expected to nearly double to 27 million by 2050[4], LTC pharmacies are vital to assuring quality of care for patients, whether in LTC facilities, such as nursing homes, assisted living communities — or at home.
But while LTC pharmacies provide important patient care and specialized services in communities across the country, a federal statutory or regulatory definition of LTC pharmacy does not currently exist. Unfortunately, LTC pharmacies are often unintentionally swept up in conflicting, confusing and irrelevant policy proposals that can threaten patient access to essential medications and related pharmacy services.
As a recent example, the absence of a clear LTC pharmacy definition became an issue during the pandemic with respect to the implementation of The Coronavirus Aid, Relief, and Economic Security (CARES) Act Provider Relief Funding.
Without a clear definition, the Health Resources and Services Administration (HRSA) was unable to include LTC pharmacies in their distribution mechanism[5], resulting in LTC pharmacies losing access to virtually all rural distributions, and in many other instances, access to any funds at all.
The Long-Term Care Pharmacy Definition Act of 2021[6] is a longstanding policy priority for Premier and its LTC pharmacy members.
Home infusion care can provide safe, clinically effective care, improve patients' quality of life and reduce healthcare costs. In fact, one study found that home infusion costs produced savings between $1928 and $2974 per treatment course versus infusions done in a medical setting[8].
Congress included provisions in the 21st Century Cures Act and the Bipartisan Budget Act of 2018 to create a professional services benefit for Medicare Part B home infusion drugs[9]. The benefit’s intent was to maintain patient access to home infusion by covering professional services including assessments; education on administration and access device care; monitoring and remote monitoring; coordination with the patient, caregivers and other providers; and nursing visits.
The issue? The Medicare home infusion therapy services benefit still needs improvement to support those beneficiaries who could - and should - receive infusions in the home.
Specifically, CMS’ implementation of the benefit requires a nurse to be physically present in the patient’s home for providers to be reimbursed. The current benefit only acknowledges face-to-face visits from a nurse and fails to account for the extensive clinical and administrative services provided remotely by home infusion clinicians.
As a result, provider participation in Medicare’s home infusion benefit has dropped sharply and beneficiaries have experienced reduced access to home infusion over the last several years[10].
Premier has long advocated for comprehensive home infusion payment reform that recognizes the important services necessary for patients to access high-quality, cost-effective treatment in their preferred setting.
With today’s healthcare environment characterized by increased competition and the movement to value, the pandemic demonstrated the value of at-home care and the ability of healthcare providers to furnish care remotely.
Looking ahead, the success of at-home care is contingent upon regulatory clarity and appropriate financial reimbursement. Absent these two keys elements working in tandem, we run the risk of losing out on the potential cost, patient experience and outcomes benefits this care setting can bring.
Learn More:
[1] https://www.acpjournals.org/doi/10.7326/M19-0600.
[2] https://www.aana.com/advocacy/federal-government-affairs/medicare-cops-and-interpretive-guidelines.
[3] https://qualitynet.cms.gov/acute-hospital-care-at-home/resources.
[4] https://www.transparencymarketresearch.com/long-term-care-services-market.html.
[5] https://seniorcarepharmacies.org/hhs-fails-to-address-pandemic-relief-for-long-term-care-pharmacies-2.
[6] https://www.congress.gov/bill/117th-congress/house-bill/5632/all-info?r=9&s=1.
[7] https://www.cms.gov/Medicare/P... Coverage/PrescriptionDrugCovContra/downloads/LTCGuidance.pdf.
[8] https://pubmed.ncbi.nlm.nih.gov/28668202.
[9] https://www.congress.gov/bill/115th-congress/house-bill/1892/text.
[10] https://www.cms.gov/files/document/hit-monitoring-report-january-2022.pdf.
[11] https://www.congress.gov/bill/117th-congress/house-bill/5067/text?r=5&s=1.
[12] https://nhia.org/wp-content/uploads/2020/03/The_Moran_Company_Home_Infusion_Policies_Score-Jan.-2020.pdf.