Shane McMahon arrived at a home in Walpole, Massachusetts, carrying a bag of medical equipment. He’s a paramedic with a hospital-at-home program run by Mass General Brigham. His patient was 91-year-old Stephanie Joseph.
“How is she feeling today?” McMahon asked Joseph’s daughter, Ketline Edouard, who translated into Haitian Creole for her mom.
“She says she’s feeling better,” Edouard replied.
Joseph has diabetes and recently went to the emergency room because of high blood sugar. After a night there, she was given the option of being part of Mass General Brigham’s Home Hospital program instead of staying in a hospital bed.
“She says: Way better, more comfortable when she’s home,” Edouard said on her mom’s behalf. “Way better than when she’s at the hospital.”
There are now 378 hospital-at-home programs like this in 39 states. Such programs began during the pandemic when the federal government provided a waiver allowing Medicaid and Medicare to pay for hospital-level care at patients’ homes. The waiver’s been extended once, but the current waiver is set to expire on December 31. If it does, any patients on Medicare or Medicaid would have to return to inpatient care, or hospitals would be out of compliance with federal regulations. Most programs wouldn’t be able to continue operating without patients receiving that federal health coverage.
Hospital-at-home programs are not the same thing as traditional home health care. The usual home health model, used for patients with less acute health care needs, involves a few visits a week for about a month. Hospital-at-home programs offer far more intensive care, usually for about five days, including several visits a day from a doctor, nurse or EMT, and 24-hour virtual monitoring of patients. Doctors say it’s ideal for patients who are dealing with a range of health challenges, including various pulmonary, cardiac and gastrointestinal conditions.
Mass General Brigham’s hospital at home program cares for 70 patients and expands their capacity, said Heather O’Sullivan, who runs the program.
“So if you just think about a 70-bed hospital, which is what we operate today, think of what that would look like in a traditional brick-and-mortar setting: how many floors, how many buildings, the workforce required for that,” O’Sullivan said.
The union National Nurses United has raised some concerns about safety of caring for patients outside of a hospital setting. But a study of hospital-at-home programs conducted last year by the Centers for Medicare and Medicaid Services said patients in these kinds of programs have lower mortality rates and higher satisfaction than brick-and-mortar hospitals. Other studies have shown the costs to be comparable to in-hospital care.
Dr. Constantinos Michaelidis is the medical director of the hospital-at-home program at UMass Memorial Medical Center in Worcester. He’s worried about the waiver expiring given how crowded hospitals already are.
“We would see much higher rates of inpatient boarding,” Michaelidis said. “We would see our emergency departments even more flooded by patients requiring care and not able to receive the care in their brick and mortar. And we would see a reversion to the capacity crises that we haven’t seen since the COVID days.”
The American Hospital Association has been lobbying Congress for an extension.
“We’re advocating for them to extend the waiver for five years to allow for that stability within the program so that those who are currently operating those programs know it’s continuing, [and] can build up and grow in those five years,” said Rachel Jenkins of the American Hospital Association.
And, she said, so other hospitals can have confidence in starting their own programs.
A five-year extension of the waiver is included in the year-end spending bill that Congress is working on this week to avert a partial government shutdown. U.S. Rep. Jim McGovern, a Democrat from Worcester, says he’d like to see that remain in the final version that passes into law.
“I’m hopeful that there will be an extension,” McGovern said, referring to the last-minute wrangling in Congress. “This place doesn’t operate like it should. I hate to say that, but that’s the reality. And we probably won’t know until the very last minute.”
And the very last minute is fast approaching.
