The Centers for Medicare & Medicaid Services on Wednesday took several new steps to help U.S. hospitals manage the crush of new patients as the COVID-19 crisis worsens. Among them are new allowances for telehealth and remote monitoring, for what CMS is calling the Acute Hospital Care at Home program.
Additionally, the agency is expanding its Hospitals Without Walls initiative, with even more regulatory flexibility for ambulatory surgery centers to provide care as a “relief valve” to help overburdened hospitals.
WHY IT MATTERS
“We’re at a new level of crisis response with COVID-19 and CMS is leveraging the latest innovations and technology to help health care systems that are facing significant challenges to increase their capacity to make sure patients get the care they need,” said CMS Administrator Seema Verma in a statement.
“With new areas across the country experiencing significant challenges to the capacity of their health care systems, our job is to make sure that CMS regulations are not standing in the way of patient care for COVID-19 and beyond.”
CMS sees the new programs as a way to build on the expansion of telehealth it offered earlier during the pandemic – enabling the capacity to offer critical non-COVID-19 care, while allowing hospitals to focus on the most recent surge in patients.
Back in March, CMS launched its Hospitals Without Walls program – allowing for care provision in locations outside hospitals.
With the new Acute Hospital Care At Home program, eligible hospitals will get further regulatory flexibility to treat eligible patients in their homes, through telehealth and remote monitoring.
“This program is designed for patients who meet acute inpatient or overnight observation admission criteria for hospital-level care,” said CMS in an FAQ on the new initiative. “The patient’s home is considered part of the hospital during the admission.”
It noted that “a program does not have to be physically administered within a hospital, but a hospital must accept responsibility for the program in order to satisfy the Conditions of Participations for this level of patient care. Additionally, the program must be integrated within a hospital to a sufficient degree to ensure that rapid escalation of care is seamless.”
CMS has set up an online portal to expedite the submission of requests to waive §482.23(b) and (b)(1) of the Hospital Conditions of Participation, which require nursing services to be provided on premises 24 hours a day, seven days a week and the immediate availability of a registered nurse for care of any patient.
The agency says it will also closely monitor the program, requiring hospitals to report quality and safety data to CMS on a frequency based on their prior experience with the hospital at home model.
THE LARGER TREND
In addition, CMS is further expanding on the latitude it offered ambulatory surgical centers to help out as surplus care providers in areas that have been hard hit by COVID-19. For more how ASCs can temporarily enroll as hospitals during the public health emergency, see this new guidance from CMS.
It’s offering more flexibility than was first allowed in the Hospitals Without Walls program – enabling participating ASCs flex up their staffing and serve as additional access points that will allow communities to maintain surgical capacity for other non-COVID-19 procedures, such as cancer surgery.
As for acute care at home, this past December Mass General Brigham conducted what it says was the country’s first randomized controlled study of hospital-level home care for acutely ill adults. It found the cost of care was nearly 40% lower for home patients than control patients – with fewer lab orders, less imaging and had fewer consultations.
Home hospital patients spent a smaller portion of their day sedentary or lying down, according to Mass General, and had 70% lower 30-day readmission rates.
ON THE RECORD
“Our research has shown that we can deliver hospital-level care in our patients’ homes with lower readmission rates, more physical mobility, and a positive patient experience,” said Dr. David Levine, medical director of strategy and innovation for Brigham Health Home Hospital, in a statement following CMS’ announcement.
“During these challenging times, a focus on the home is critical,” he said. “We are so encouraged that CMS is taking this important step, which will allow hospitals across the country to increase their capacity while delivering the care all patients deserve.”
“The patients we have served in Home Hospital during the COVID-19 pandemic have been particularly grateful for the opportunity to be treated in the comfort of their home – especially elderly patients and patients with chronic medical conditions,” added Dr. Ryan Thompson, director of MGH Home Hospital. “As hospital capacity has become more and more strained, having the ability to send patients home with hospital-level services has been enormously helpful to patients and our hospitals.”