Home health pursues hospital-at-home despite Medicare pay concerns

Hospital-at-home is attracting a new field of providers who say they can sustain the model despite uncertainty over how Medicare will reimburse for the service in the future. Home health agencies and even senior living companies are launching versions of hospital-at-home that don’t rely on reimbursement from Medicare fee-for-service.

The CMS Acute Hospital at Home Waiver launched in November 2022, which allows hospitals and health systems to treat patients outside of their walls, is set to expire at the end of 2024. Medicare reimburses hospitals at the same rate for in-home care as it does for an in-facility stay. However, the waiver requires patients to visit an emergency department or be a patient in a hospital before being transferred to hospital-at-home.

But other payers don’t have that requirement, making it easier for home health agencies and other providers to launch hospital-at-home programs without the threat that Medicare reimbursement might change.

Senior health company Lifespark — which provides primary care, home health and hospice services, and owns 40 senior living facilities in Minnesota and Wisconsin — plans to launch a hospital-at-home program by year’s end. The St. Louis Park, Minnesota-based company piloted a similar program in partnership with North Memorial Hospital in Minneapolis for about six weeks in 2020 during the COVID-19 pandemic. 

Lifespark takes on full risk for approximately 25,000 older adults through value-based care arrangements with Medicare Advantage plans. Founder and CEO Joel Theisen said the hospital-at-home program under development would target those patients and will likely include collaboration with hospitals.

“We can intercept at the hospital and transition [them] early to acute-care-at-home,  » Theisen said.

Home health providers CenterWell, Elara Caring, Enhabit and Home Instead have forged partnerships in recent months with in-home healthcare provider DispatchHealth to provide hospital-level care to clients. The Denver-based company sends emergency medical technicians and nurse practitioners into the homes to evaluate patients under the virtual direction of a physician. Patients requiring hospital-level care can be enrolled in DispatchHealth’s acute-care-at-home program. The service is covered under many Medicare Advantage plans, managed Medicaid plans and private health plans.

“We essentially receive a bundled payment for that episode and we provide all of the necessary care,” said DispatchHealth Founder and CEO Dr. Mark Prather. 

Healing Hands, a Dallas-based home health company, launched hospital-at-home in 2018 and gets reimbursed through the CMS’ home health prospective payment system. Payments cover nursing care, telehealth, remote patient monitoring and home healthcare – all components of hospital-at-home.

Healing Hands CEO Summer Napier said her company identifies those home health clients whose conditions are deteriorating and require acute-level care, and then works with primary care physicians to transition those patients to its hospital-at-home program. Napier said Healing Hands has provided hospital-at-home care to approximately 900 patients so far. 

The home health model could provide a possible guide to CMS as it considers the future of hospital-at-home reimbursement after the Medicare waiver expires. A study last year by healthcare consultancy Milliman said designing a Medicare reimbursement approach for hospital-at-home based on a home health payment, with additional payments for expanded services, could be less costly than a hospital-centered payment.

A home health-based Medicare fee-for-service payment could encourage more home health providers to add hospital-at-home. But Dr. Robert Moskowitz, chief medical officer for hospital-at-home company Contessa Health, said it can be challenging for some home health agencies to scale hospital-at-home if they don’t have the appropriate technology or staff.

“A lot of home health entities might be employing home health nurses, but they’re not used to that [higher] level of acuity,” Moskowitz said. “You’ve got to have the comfort level of competency for the nurse providing the care.”