Pioneering care: Insights from CMS’ Hospital-at-Home initiative
Former CMS official Lee Fleisher, MD, discusses the impact and future of offering acute hospital care in patients’ homes.
The Centers for Medicare & Medicaid Services’ Acute Hospital Care at Home (AHCAH) initiative was a game-changer when it launched in November 2020. This waiver-granting process enabled individual CMS-approved hospitals to explore various practical models for treating sicker patients at home. Championed by longstanding advocates for hospital-based home care, AHCAH was extended through Dec. 31, 2024, as part of the Consolidated Appropriations Act of 2023.
On Nov. 3, 2023, the former chief medical officer and director of the Center for Clinical Standards and Quality for CMS (2020-2023), Lee Fleisher, MD, and his former colleagues at CMS published a report on the initial findings through March 2023 from AHCAH in JAMA Health Forum.
Fleisher is emeritus professor of anesthesiology and critical care and professor of medicine at the University of Pennsylvania Perelman School of Medicine and principal at Rubrum Advising. He also serves as a senior advisor of the Bipartisan Policy Center and FasterCures of the Milken Institute, senior fellow of the Leonard Davis Institute of Health Economics and visiting fellow of the Duke-Margolis Center. He is the former chief medical officer and director of the Center for Clinical Standards and Quality for Centers for Medicare & Medicaid Services (2020-2023).
As Congress evaluates the future of Hospital at Home, this report came at an opportune time to assess and address successful program models. In the following Q&A, Fleisher discusses his keynote address at the Hospital @ Home Leadership Summit (Nov. 29 to Dec. 1, 2023, Scottsdale, Ariz.), at which he provided an in-depth analysis of the report’s data and findings.
To start, could you speak to how this report came to be?
Prior to my departure from the agency, Congress had asked CMS – at the request of many groups who have lobbied to extend the waiver – to understand the benefits of home-based hospital care, the risks around program integrity and the overall cost. This is at the heart of the study that’s been requested as part of the Consolidated Appropriations Act of 2023. The initial findings we published in JAMA will help inform some of the statutory changes that Congress will need to make to continue inpatient care in the home.
What advice would you give to an organization looking to launch a Hospital at Home program or scale an existing program?
Other speakers at the Hospital @ Home Leadership Summit can speak to best practices. My lecture is how to best think about the regulatory framework as Congress looks at the question of whether or not to extend the program.
My talk will inform organizations about how to ensure they’re practicing in a way that maintains program integrity and that leads to better outcomes. Because the real questions from Congress are: How do we ensure that this is not home health but truly hospital level and required care in the home? How much does that cost to deliver? How do we ensure that patients are safe? And lastly, are there certain types of patients that are better suited for this program?
Where do you think Hospital at Home might be in the next five years?
I think a lot will depend on the community. I’ve said this publicly – if Hospital at Home is part of a total cost of care model, I think there’ll be a lot of interest in its advancement. But if organizations expect to be paid in a traditional fee-for-service model, I don’t know where that program will go. A lot will depend on how those in this field interpret CMS’ recent data and work with Congress to craft an appropriate program through statute.
Anything else you’d like to share?
As the senior author on this CMS publication, I can offer guidance as to how the hospital at home community should interpret and talk about this data.
This is brand new data coming out at a time when Congress is considering whether or not to extend the program. I think it’s critical to frame the experience within the safeguards under which this program was developed. One of the key questions to discuss is — what are those critical safeguards we’ve implemented in the program that need to continue the program to make sure it remains safe?
Learn more about Fleisher and the program here.
Originally published by ICD on Nov. 17, 2023.
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