SHM Joins Multi-stakeholder Letter Urging Congress to Extend Hospital at Home Waiver
March 11, 2024
SHM's Policy Efforts
SHM supports legislation that affects hospital medicine and general healthcare, advocating for hospitalists and the patients they serve.
The Honorable Jason Smith
Chairman
Ways & Means Committee
Washington, DC 20510
The Honorable Richard Neal
Ranking Member
Ways & Means Committee
Washington, DC 20510
RE: Requesting Extension of the Acute Hospital Care at Home Waiver
Dear Congressmen Smith and Neal,
The undersigned stakeholders, representing Hospital-at-Home (HaH) programs, physicians, physician assistants, pharmacists, nurses, emergency medical technicians, paramedics, patient advocacy organizations, hospitals, health systems, and care model enablers, are writing to ask for at least a 5-year extension of the Acute Hospital Care at Home waiver program (AHCaH) before its expiration at the end of 2024. Without an extension, Medicare beneficiaries will lose access to HaH programs that have been demonstrated to provide excellent clinical outcomes and lower the costs of care.
Medicare created the AHCaH waiver at the height of the COVID-19 pandemic as part of a broad strategy to help alleviate hospital capacity issues. Prior to the implementation of the AHCaH waiver, approximately 20 HaH programs existed across the U.S. After the waiver, more than 300 hospitals across 129 health systems in 37 states are operating under the waiver—with no guarantee of payment permanence.1,2 That represents approximately 5% of all U.S. hospitals and 15% of academic medical centers. Clinical outcomes of the AHCaH program have been outstanding.3,4 At this current trajectory, 1 in 6 hospitals will have HaH by 2030, allowing hospital care to be delivered to more patients in the safety and comfort of their homes nationwide
Hospital-at-Home has a long history. Over the past 30-plus years, HaH researchers have found through numerous studies that patients and family caregivers prefer HaH, which delivers excellent clinical outcomes, including substantial reductions in adverse events (e.g., mortality), better patient and family experience, lower caregiver stress, better functional outcomes, high provider satisfaction, and lower costs of care.5 As a result of these studies, we firmly believe that the AHCaH waiver, which provides appropriate payment for acute hospital-level care delivered at home, is the keystone to the future of home-based care delivery for Medicare patients and beyond.
To achieve this future, the waiver must be extended to enable hospitals and health systems nationwide to continue building out the logistics, supply chain, and workforce for Hospital-at-Home (HaH) and to encourage multiple payers outside the Medicare program, including Medicaid programs, to enter the HaH market. An extension will also allow home-based services to be developed equitably across populations everywhere and ensure hospital inpatient unit care is available for the patients who need it while enabling patients who can and want to be treated in their home to have the opportunity to do so, creating needed capacity for hospitals without increasing health system costs.
In order to avoid any disruption in access to Medicare beneficiaries, we ask that you extend the Medicare Acute Hospital Care at Home waiver program for at least five years before the end of 2024. We thank you for the opportunity to provide input on the Hospital-at-Home program and provide our ideas for the future of the program. For more information on the HaH research and testing, please visit here. Should you have any questions, please reach out.
Respectfully submitted,
Acadian Ambulance Service, Inc.
Acadian Health
Advocate Health
Alliance for Connected Care
American Academy of Home Care Medicine
American Medical Association
American Paramedic Association
Appalachian Regional Healthcare, Inc.
Atrium Health
Avera Health
Baptist Health
Bellin Health
Best Buy Health Inc., a Best Buy Company
Beth Israel Deaconess - Lahey Health
Biofourmis, Inc.
Blessing Health System
ChristianaCare
CommonSpirit Health
DispatchHealth
eShift Remote Care Delegation
GE HealthCare
Geisinger
Hackensack Meridian Health
Hattiesburg Clinic
Health First Brevard County, FL
Henry Ford Health
Inbound Health
Intermountain Health
Johns Hopkins Health System
Kent Hospital, Warwick, RI; a member of Care New England Health System
Maribel Health
Marshfield Clinic
Mass General Brigham
Medically Home
Mercy Hospital at Home
Michigan Medicine
Mount Auburn Cambridge IPA
Mount Sinai Health System
Moving Health Home
MultiCare Health System
NYU Langone Health
Ochsner Health
Origin Healthcare
Orlando Health
OSF OnCall
Right at Home
Roper Saint Francis Healthcare
Saint Peter's Healthcare System
Sanford Health
Shields at Home
Society of Hospital Medicine
St. Bernard's Healthcare
SwedishAmerican Medical Group, UWHealth Northern IL Region
Tampa General Hospital
Texas Health Resources
The American Telemedicine Association
The Coalition to Transform Advanced Care
The Ohio State University Wexner
Medical Center
UC Davis Health System
UMass Memorial Health
UNC Health Pardee
Vanderbilt University Medical Center
Virginia Commonwealth University
Health System; VCU Health
Virginia Mason Franciscan Health
Virtua Health
1 Levine, David M., Jeffrey Souza, Jeffrey L. Schnipper, Thomas C. Tsai, Bruce Leff, and Bruce E. Landon. "Acute Hospital Care at Home in the United States: The Early National Experience." Annals of Internal Medicine (2024).
2 "Approved Facilities/Systems for Acute Hospital Care at Home." CMS QualityNet. January 26, 2024. https://qualitynet.cms.gov/acute-hospital-care-at-home/resources.
3 Adams, Danielle, Ashby J. Wolfe, Jessica Warren, Alexandre Laberge, Adam C. Richards, Kurt Herzer, and Lee A. Fleisher. "Initial findings from an acute hospital care at home waiver initiative." In JAMA Health Forum. American Medical Association (2023).
4 Clarke Jr DV, Newsam J, Olson DP, Adams D, Wolfe AJ, Fleisher LA. Acute hospital care at home: the CMS waiver experience. NEJM Catalyst Innovations in Care Delivery (2021).
5 Federman, Alex D., Tacara Soones, Linda V. DeCherrie, Bruce Leff, and Albert L. Siu. "Association of a bundled hospital-at-home and 30-day post-acute transitional care program with clinical outcomes and patient experiences." JAMA Internal Medicine (2018).