Evaluating the Acute Hospital Care at Home (AHCAH) Initiative
By Tiffany Ferguson, LMSW, CMAC, ACM
The Centers for Medicare & Medicaid Services (CMS) has released a report on the Acute Hospital Care at Home (AHCAH) initiative, a program allowing select Medicare-certified hospitals to provide inpatient-level care within patients’ homes.
Originally launched to address hospital capacity challenges during the COVID-19 pandemic, the initiative has continued under the Consolidated Appropriations Act of 2023 (CAA), which extended the program’s flexibilities until Dec. 31, 2024. The recent report fulfills a mandate from the CAA to evaluate AHCAH and analyze its impact across multiple areas, including patient demographics, quality of care, and cost-effectiveness.
The study found that participating hospitals used a range of criteria to identify eligible AHCAH patients. These criteria, based on established hospital-at-home literature, ensure that selected patients are clinically appropriate for home care, and that their home environments are safe and conducive to receiving such care.
The report also highlighted demographic differences between AHCAH patients and traditional inpatients, showing that AHCAH patients were more likely to be white, live in urban areas, and have higher incomes, with fewer receiving Medicaid or low-income subsidies.
The report found that AHCAH primarily treated patients with a relatively small set of conditions, including respiratory and circulatory conditions, renal conditions, and infectious diseases. By grouping these conditions under MS-DRGs, CMS was able to compare treatment outcomes in AHCAH versus traditional inpatient settings. The findings provided insight into the types of cases that were most suitable for home-based acute care, suggesting that AHCAH may be particularly effective for certain known manageable conditions.
The CMS report also examined the quality of care provided under the AHCAH initiative. It assessed metrics like 30-day mortality rates, 30-day readmission rates, and the occurrence of hospital-acquired conditions (HACs). The findings indicate that AHCAH patients generally had lower mortality rates than their hospital-based counterparts.
Readmission rates, however, varied by condition, with AHCAH patients showing significantly higher rates for some conditions and lower rates for others; however, these specific conditions were not mentioned in the publicly released fact sheet. HAC rates were lower for AHCAH patients, although differences were not statistically significant.
When evaluating cost and utilization, the report focused on factors like length of stay, Medicare spending after discharge, and hospital service use, including telehealth services. AHCAH patients typically had longer lengths of stay, but incurred lower Medicare spending, in the 30 days following discharge. While these findings suggest cost benefits, the complex nature of AHCAH’s patient selection and clinical conditions makes it difficult to draw definitive conclusions about overall savings compared to inpatient hospital settings, according to CMS.
CMS hosted virtual listening sessions to gather feedback from patients and caregivers involved in AHCAH. The responses were generally positive, with patients appreciating the convenience and personal nature of home-based care. Clinicians, too, reported favorable experiences, which aligned with broader hospital-at-home research indicating high satisfaction rates among patients receiving care at home.
The report concluded with a need for further research and development, including refining cost, quality, and utilization metrics.
With the AHCAH initiative set to expire at the end of 2024, its continuation depends on future congressional action.