Home-based care companies, including Amazon Care and two health systems, are lobbying Congress to make permanent changes to home health care reimbursement policies.
Intermountain Healthcare and Ascension are two of the founding members of the Moving Health Home coalition, which aims to change the way policymakers think about the home as a site of clinical service.
The COVID-19 pandemic exposed the untapped potential of home-based clinical care and the opportunity for a more robust set of services ranging from primary care to hospital-level treatment, the coalition said in a press release.
"The advent of telehealth, remote monitoring, digital therapeutics, provider home visiting, medical records sharing, and other technology has shown that care in the home can be at least equivalent to, if not better than, care offered in facilities," the organizations said.
Other members of the coalition are home-based providers Amazon Care, Landmark Health, Signify Health, Dispatch Health, Elara Caring and Home Instead.
In 2019, Amazon announced it was piloting a new virtual health service benefit for employees and their families in the Seattle region called Amazon Care. The tech giant said the service combines "the best of both virtual and in-person care" by offering virtual visits, in-person primary care visits at patients' homes or offices and prescription delivery.
Moving Health Home says it has five policy priorities, and top of the list is pushing for Medicare coverage of higher-acuity home-based services, such as emergency services. The group also wants policymakers to create an extended care benefit that would serve as a home-based alternative for skilled nursing facility care.
The coalition also is advocating for permanent "Hospital without Walls” site of care flexibility to support home-based hospital services.
The coalition also wants home-based evaluation and monitoring services to be reimbursed at the same rate as the 2022 Medicare Physician Fee Schedule for what primary care office visits are paid.
"Over 17% of Medicare beneficiaries are living with 6 or more chronic conditions. In-home, patient-centered care is critical to managing the complex health needs of our nation's older adults. We need a public policy agenda that ensures access to innovative in-home care," said Nick Loporcaro, CEO at Landmark Health.
Different types of home health services have existed for decades, but these services are short-term and designed to help patients—mainly seniors—prevent or recover from an illness, injury or hospital stay. Making the home part of the regular options available to patients will allow for primary care, behavioral health, chronic disease management and even hospital-level care in the home, the coalition said.
Technology and regulatory changes have made at-home care offerings more available than ever.
In March 2020, the Centers for Medicare & Medicaid Services (CMS) announced the Hospitals Without Walls program, which provides broad regulatory flexibility that allowed hospitals to provide services in locations beyond their existing walls. Under this temporary policy, hospitals can transfer patients to outside facilities such as ambulatory surgery centers, inpatient rehabilitation hospitals, hotels and dormitories, while still receiving hospital payments under Medicare.
CMS expanded that policy in November when it launched the Acute Hospital Care At Home program. These new regulatory flexibilities allow hospitals to provide acute care services at home for Medicare beneficiaries for conditions that would otherwise require hospitalization, such as congestive heart failure and chronic obstructive pulmonary disease (COPD).
CMS’s Advanced Hospital Care at Home only covers patients admitted directly from hospitals. There are currently 48 systems and 109 hospitals in 29 states participating in CMS' hospital-at-home program.
Some health systems, like Mount Sinai and Intermountain, have built their own hospital-at-home programs. Other providers such as Mayo Clinic and UNC Health have partnered with company Medically Home to provide hospital-level, high-acuity care to patients.
There also are companies such as DispatchHealth that provide hospital care without the hospitals and tend to focus on low acuity health issues.
The CMS waivers for home-based care announced in March and November represented a watershed moment that the home is being recognized as an important site of care, Medically Home CEO Rami Karjian told Fierce Healthcare.
Health systems including Mayo Clinic and Adventist Health, enabled by Medically Home, have treated more than 1,000 patients at home to date in six states. Medically Home, which is not a part of the coalition, works with hospitals to provide high-acuity care to high-complexity patients who would otherwise be hospitalized for over 100 serious illnesses, including exacerbation of chronic diseases, such as heart failure and COPD), infections, such as pneumonia and cellulitis, and post-surgical hospitalizations.
The coalition's efforts to change reimbursement polices underpins the growing interest in shifting more care to patients' homes, he said.
"My read is on this alliance is they are focused on home as a site of care more broadly, while we are focused on high-acuity hospital care at the home," he said.