Hospital-at-Home (HaH) care provides acute hospital-level care in a patient’s home as a substitute for traditional inpatient care. In 2017, the Physician-Focused Payment Model Technical Advisory Committee recommended implementation of an alternative payment model for a new model of HaH that bundles an acute episode with 30 days of post-acute transitional care.

Alex Federman, MD, MPH, and colleagues sought to determine the association of providing HaH care bundled with a 30-day post-acute period of home-based transitional care with clinical outcomes and patients’ experiences compared with traditional inpatient care. “We engaged patients with select diagnoses in HaH and separately recruited patients who were receiving traditional in-hospital care to serve as a comparison group,” says Dr. Federman. “Patients were interviewed at the beginning of their episode of acute care and 2 and 4 weeks later. We also obtained Medicare claims data to determine if they had a hospital readmission.”

In the case-control study, HaH patients had shorter lengths of stay (3.2 days vs 5.5 days), lower readmission rates (8.6% vs 15.6%), fewer ED revisits (5.8% vs 11.7%), less skilled nursing facility admissions (1.7% vs 10.4%), and a greater likelihood of rating their hospital care highly (68.8% vs 45.3%).

Dr. Federman says that physicians should encourage their patients to participate in HaH care when available. “From a policy standpoint, physicians should encourage CMS and the Secretary of HHS to provide a billing mechanism for HaH so that it can be made available to more patients,” he adds. “HaH provides patients with a safe, effective, and convenient alternative to inpatient hospital care and is a truly patient-centered mode of healthcare delivery.”

References

Federman A, Soones T, DeCherrie L, et al. Association of a Bundled Hospital-at-Home and 30-Day Postacute Transitional Care Program With Clinical Outcomes and Patient Experiences. JAMA Intern Med. 2018;178(8):1033-1040. Available at
https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2685092.