•      "THE ACUTE HOSPITAL CARE AT HOME PROGRAM CANNOT PROVIDE ACUTE HOSPITAL-LEVEL CARE IN A PATIENT’S HOME…CMS’s AHCaH program endangers patients requiring acute hospital-level care by allowing hospitals to treat them in their homes. The AHCaH program builds on previous blanket Covid waivers for the hospital industry, including the Hospitals Without Walls program. Blanket waivers allow hospitals to bypass certain CMS requirements so they do not have to apply for an individual waiver, though the AHCaH program does require an individual

waiver application. The AHCaH program waives numerous Medicare provider requirements and patient safety standards that apply to acute care hospitals, including nursing, medical, and emergency services requirements… Moreover, after a doctor performs an initial medical history and physical exam for an AHCaH patient, CMS does not require any additional in-person registered nurse or doctor visits with the patient. Instead, the AHCaH program requires just two in-person patient visits a day by a community paramedic. These lower standards for nursing, medical, and emergency care under the AHCaH program put patients’ lives at risk." Source: National Nurses United (NNU)

•      "Though AHCAH probably played a negligible role in increasing hospital capacity during the PHE, the limited uptake likely reflects the implementation challenges that hospitals faced, challenges that may present fewer obstacles as providers gain more familiarity with the model. Whether providing AHCAH is less costly for hospitals than providing conventional brick-and-mortar care is a critical unresolved question that may affect the take-up of the program. The Commission’s interviews with hospitals participating in AHCAH found that beneficiaries receive fewer services (such as physician consults and laboratory tests) during an AHCAH stay than during a conventional inpatient stay. Nevertheless, the cost per unit of service may be higher due to the additional costs and inefficiencies of providing care to patients in their homes. Whether AHCAH can provide value to beneficiaries and the Medicare program—through better outcomes and reduced Medicare expenditures for follow-on care—has yet to be conclusively determined" Source: Medicare Payment Advisory Commission (MedPac)

•      "But questions remain about the program’s cost, effectiveness, and its impact on uncompensated family caregivers…Sachin Jain, president and CEO of SCAN Health Plan, says policy makers and fellow program supporters should tap the brakes on the “toxic positivity” surrounding the hospital-at-home (HaH) movement. I just think that sometimes in the course of launching new programs, there’s a bit of toxic positivity that ‘everything is better’ and nothing is worse,” Jain said. “And I’m just trying to inject a dose of realism, which is that there are some real-world patient challenges associated with the program.” While the program guidelines don’t call for family members to provide supplemental care for beneficiaries, Jason Resendez, CEO of the National Alliance for Caregiving, said that’s unrealistic. Family members have reported not even knowing their loved ones were part of the hospital-at-home program as they were “left navigating all of this additional care that’s taking place in the home,” he said. “So, clearly while the expectation is not there,” for family caregiver support, “in reality, we see it playing out,” Resendez said. “We need to better understand that in a rigorous qualitative and quantitative way." Source: Tony Pugh, Bloomberg Law