by Tim Rowan, editor
CMS has revealed a new program it describes as "unprecedented." Administrator Seema Verma says the new program will increase the capacity of the American health care system to provide care to patients in their homes. One would think this would be welcome news to beleaguered home health agencies who have lost so many patients and staff to COVID-19. The words "Home Health," however, do not appear anywhere in the announcement, except when describing the limits of our sector's capabilities.
This new program, to be known as "Acute Hospital Care at Home," is made possible by relaxed telehealth regulations that CMS will make permanent after trying them out in response to the pandemic emergency. The announcement explained:
"These flexibilities include allowances for safe hospital care for eligible patients in their homes and updated staffing flexibility designed to allow ambulatory surgical centers (ASCs) to provide greater inpatient care when needed. Building on CMS's previous actions to expand the availability of telehealth across the nation, these actions are aimed at allowing health care services to be provided outside a hospital setting while maintaining capacity to continue critical non-COVID-19 care, allowing hospitals to focus on the increased need for care stemming from public health emergency."
What You Can Do Right Now
There are two bills before Congress that may remove the legal restrictions preventing CMS from reimbursing Home Health for providing telehealth services.
State and national associations are asking every provider to support the HEAT Act, the collective name for Senate Bill 4854 and House Bill 8677.
A complete description, with steps to take right now, are available from the NAHC Legislative Action Center.
"We're at a new level of crisis response with COVID-19 and CMS is leveraging the latest innovations and technology to help health care systems that are facing significant challenges to increase their capacity to make sure patients get the care they need," said CMS Administrator Seema Verma. "With new areas across the country experiencing significant challenges to the capacity of their health care systems, our job is to make sure that CMS regulations are not standing in the way of patient care for COVID-19 and beyond."
It appears that Ms. Verma is asserting that homebound patients get care when a hospital system provides it but not when a Home Health nurse provides it.
To justify easing regulations to bring hospital-level services to people who cannot, or will not, leave their homes, the announcement describes the new program as one that permits actual acute care in the home, including remote patient monitoring after surgery. This program was developed to support models of at-home hospital care throughout the country that have seen prior success in several leading hospital institutions and networks, and reported in academic journals, including a major study funded by a Healthcare Innovation Award from the Center for Medicare and Medicaid Innovation (CMMI).
The program clearly differentiates the delivery of acute hospital care at home from more traditional home health services. "While home health care provides important skilled nursing and other skilled care services, Acute Hospital Care at Home is for beneficiaries who require acute inpatient admission to a hospital and who require at least daily rounding by a physician and a medical team monitoring their care needs on an ongoing basis," Ms. Verma added.
Ambulatory Surgical Centers normally keep patients in their care for less than 24 hours. One of the new regulations will allow them to be temporarily certified as hospitals and to provide inpatient care for longer periods than normally allowed, as long as appropriate staffing is in place. CMS expects this flexibility will allow these and additional ASCs enrolled as hospitals to serve as an added access point that will allow communities to maintain surgical capacity when hospitals filled with COVID-19 patients suspend life-saving surgeries.
Describing its expansion of telehealth coverage as critical "to keep beneficiaries safe and prevent the spread of COVID-19," the announcement noted that "Medicare beneficiaries will be able to receive telehealth services from any location, including their homes." Expansion will include over 135 other services, such as emergency department visits, initial inpatient and nursing facility visits, and discharge day management services, that could be paid when delivered by telehealth.
Just not when provided by Home Health Agencies.
©2020 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Home Care Technology: The Rowan Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. firstname.lastname@example.org