Decoding the Latest CMS Changes and Their Impact on Home Hospital Care

The first half of 2020 has affected every facet of the healthcare landscape. From insurance coverage to pharmaceutical research and the delivery of care, there are few areas that have not been impacted by COVID-19 and the corresponding series of regulation changes. Home hospital care is no exception to this disruption, and we at Contessa have been closely watching every move from the Centers for Medicare and Medicaid Services (CMS).

As the pandemic goes on, some of the nation’s top health systems and health plans are seeing the link between a robust home hospitalization platform and improved treatment of COVID-19. By bringing care into the home, hospitals’ capacity is improved, care becomes safer, and patient satisfaction increases. That’s true in normal times, and it’s proving true during a global health crisis.

This was actualized by the Carr family of Wisconsin, whose entire family was diagnosed with COVID-19 earlier this year. Suzzanne, her husband Bill, mother, two daughters and granddaughter all contracted the virus. It sent four of them to the Marshfield Clinic.

When Suzzanne went to the emergency room, she learned she was eligible to receive her hospital care at home and seized the opportunity. Three other family members were admitted to the hospital, but two, including Bill, were able to go home with Home Recovery Care and complete their hospitalization at home once they were stable.

“I was very pleased with the service, it was excellent,” said Bill. “There were days when I felt rough, but I knew I could always call my Recovery Care Coordinator. I think I healed better at home than I would have if I stayed in the hospital.”

With this one family, our care-model opened up three beds for patients in need at a time essential to preserving the hospital’s capacity. Continuing this practice-long term creates capacity in the same way and will drive sustained patient satisfaction.

However, despite its proven success in the U.S. and abroad, today’s federal regulatory landscape continues to prevent the hospitalization at home model from reaching its full potential. Currently, outdated policies and regulations would keep patients in less preferred and less safe settings that cost more and don’t provide adequate isolation to prevent the spread of the virus.

Thanks to emergency “Hospital Without Walls” waivers, CMS opened the door to making at-home care more accessible to the hundreds of thousands of patients who can benefit from it. But some elements of the waiver are not explicit.  In addition, it remains unclear how long the agency will continue to pay for this innovative model of care.

If we read the tea leaves with some optimism, however, perhaps CMS is laying the groundwork for future reimbursement solutions, and these recent waivers may mark the turning point in making the patient’s home an acceptable site for hospital-level treatment.

For starters, it’s the logical business decision. Unfortunately, however, COVID has proven that it’s also a matter of patient safety. In July, The Wall Street Journal ran a story titled, “Hospitals Struggle to Contain Covid-19 Spread Inside Their Walls,” which said “U.S. medical centers have reported 5,000-plus cases of patients likely catching the coronavirus once admitted for other conditions.” (Worth noting: That number only includes cases hospitals voluntarily self-reported.)

Heightening the urgency, polling shows patients have an understandable aversion to receiving healthcare right now. Though they can abstain for some time, it is not in anyone’s best interest to delay necessary care. Contessa and other home care providers have the ability to reduce the risk or likelihood of more dangerous conditions arising because we can provide care in a safer setting that is more amenable to patients.

The cautious and measured implementation of changes by CMS is a cycle we are all familiar with. But there may be a more expedient path.

State agencies often move more quickly in evolving their reimbursement models, and that is where our company and our partners are hoping to see positive change take effect before any substantial movement at the federal level.

What we do know is that it’s more important than ever for our sector of the healthcare industry to continue exploring novel care delivery options for the health and wellbeing of all. Based on the compelling evidence we have seen thus far, we are confident that providers who adopt home hospital care models will weather the COVID-19 storm better than those who don’t. And the same is true for states who proactively pass legislation to make this care available to the people they serve.