Hospital At Home Is Not Just For Hospitals

Health Affairs | By Pamela Pelizzari, Bruce Pyenson, Anna Loengard, Matthew Emery
 
Hospital at Home programs deliver needed services to appropriate patients in their homes and can effectively serve patients, payers, and providers. The programs provide physician visits, drugs, monitoring, nursing services, diagnostics, and other services at a level typically reserved for patients in inpatient settings. A typical Hospital at Home patient has features that make home care preferable, for example, they may present to an emergency department with uncomplicated, simple pneumonia, have no significant comorbidities, and live with a partner who can provide basic care, such as preparing meals. Studies have shown these programs have lower readmission rates, lower payer costs, and higher patient satisfaction. Patients prefer their homes, payers prefer having patients get care in the least acute setting possible, and hospital providers want to have beds available for patients who need them.
 
While Hospital at Home programs have been studied since the 1970s, adoption had been slow until the COVID-19 public health emergency (PHE) prompted the Centers for Medicare and Medicaid Services (CMS) to waive the Medicare Hospital Conditions of Participation to enable the use of this care delivery model for Medicare beneficiaries. In 2020, CMS implemented the Acute Hospital Care at Home Waiver, which establishes Medicare payment for home hospitalizations. The combination of the PHE and CMS’s regulatory response has generated huge demand for Hospital at Home. By July 2021, eight months after the Acute Hospital Care at Home Waiver program was established, more than 140 hospitals across 66 health systems were approved by CMS to provide hospital services in a home setting. Because of COVID-19, patients and providers have quickly embraced telehealth, and that “stay at home” attitude may bring Hospital at Home into the mainstream. In 2019, the Medicare population had more than 800,000 hospitalizations, which could have qualified for Hospital at Home. As the care delivery model grows in the post-PHE, some important questions remain, such as how insurers will reimburse providers for Hospital at Home services and the types of provider organizations that will embrace this novel care delivery model.
 
Top-Down And Bottom-Up Payment Approaches
 
Medicare currently pays for Hospital at Home using a top-down (hospital-centered) payment—the payment is made to hospitals, and the amount is based on Medicare’s payment system for acute inpatient admissions. An alternative, bottom-up approach could generate a payment amount on the basis of existing home-based care payment systems, with additions for the expanded services needed for the more acute patients in a Hospital at Home model. Because home care providers are typically reimbursed at lower rates, this approach to payment would be less expensive and could capitalize on the existing in-home care expertise these providers have, while expanding their reach to a higher-acuity patient population. The co-authors have compared payment options for home hospitalization programs under both the top-down and bottom-up approaches.

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Monkeypox Virus Infection in the United States and Other Non-endemic Countries—2022

Cases of monkeypox have previously been identified in travelers from, or residents of, West African or Central African countries where monkeypox is considered to be endemic. CDC is issuing this Health Alert Network (HAN) Health Advisory to ask clinicians in the United States to be vigilant to the characteristic rash associated with monkeypox. Suspicion for monkeypox should be heightened if the rash occurs in people who 1) traveled to countries with recently confirmed cases of monkeypox, 2) report having had contact with a person or people who have a similar appearing rash or received a diagnosis of confirmed or suspected monkeypox, or 3) is a man who regularly has close or intimate in-person contact with other men, including those met through an online website, digital application (“app”), or at a bar or party. Lesions may be disseminated or located on the genital or perianal area alone. Some patients may present with proctitis, and their illness could be clinically confused with a sexually transmitted infection (STI) like syphilis or herpes, or with varicella zoster virus infection. Read the full report at Monkeypox Virus Infection in the United States. 

Additional information on Monkeypox can be found here: Monkeypox | Poxvirus | CDC 

COVID-19 Booster Now Available for Children Aged 5-11 Years

The U.S. Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC) recently authorized and endorsed a single booster dose of the Pfizer-BioNTech COVID-19 vaccine for children aged 5-11 years at least five months after completion of a Pfizer-BioNTech COVID-19 vaccine primary series. The Centers for Medicare & Medicaid Services (CMS) will continue to ensure that coverage is available for this critical protection from the virus that causes COVID-19, including this new booster dose, without cost sharing.

The best way to protect yourself and your children from COVID-19 is to get vaccinated. Parents, if you have not gotten vaccinated, or have not taken your children to get vaccinated, now is the time. Continued safety monitoring shows that the COVID-19 vaccines are safe for children and teens. In addition, they are effective at preventing severe illness from infection with the virus.

CMS is helping to ensure that cost is not a barrier to access, including for boosters. The federal government is providing vaccines free of charge to everyone 5 years and older living in the United States, regardless of their immigration or health insurance status. People can visit vaccines.gov (English) or vacunas.gov (Spanish) to search for vaccines nearby.

CMS continues to explore ways to ensure maximum access to COVID-19 vaccinations and boosters. There are numerous resources available. Organizations can use the free, customizable materials from the web available through this web page CMS COVID-19 web page. This important information can be utilized in their outreach efforts year-round, including digital videos, palm cards, posters, infographics, social media messages, graphics, and more.

Please share these materials, bookmark these pages, and check back often for the most up-to-date information. It is important to us that we help encourage our beneficiaries and consumers –especially those with chronic conditions – to protect themselves and their loved ones from COVID-19.

Surgeon General Issues Landmark Report with New Solutions to Combat Crippling Worker Burnout Issue

Fierce Healthcare | By Robert King
 
Healthcare worker burnout was a staggering issue for systems across the country even before the pandemic, and, now, a new report from the U.S. surgeon general hopes to help by boosting benefits and reducing administrative burdens. 

Surgeon General Vivek Murthy, M.D., released a general advisory Monday surrounding worker burnout, an issue that was present before the pandemic but only worsened as COVID-19 has impacted systems. Murthy is pressing for collaboration among regulators, health systems, communities and other key stakeholders to take a “whole-of-society” approach to the problem.

“COVID-19 has been a uniquely traumatic experience for the healthcare workforce and for their families, pushing them past their breaking point,” Murthy said in a statement. “Now, we owe them a debt of gratitude and action. And if we fail to act, we will place our nation’s health at risk.”

Murthy’s advisory lays out a series of recommendations to combat burnout, which is likely to get worse with more than half a million registered nurses retiring by the end of the year and a shortage of more than 3 million low-wage health workers projected over the next five years. The Association of American Medical Colleges has also projected a shortage of 139,000 physicians by 2033.

[Click to read the recommendations], which come roughly a month after a new survey from the union National Nurses United showed major spikes in workplace violence at systems across the country.

The surgeon general advisories do not have any binding actions but are an attempt to call attention to a public health issue.