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Over the last several years, hundreds of hospitals around the country have created programs for treating patients in their homes. This level of care previously could only be provided for inpatients, but a federal waiver that allowed them to bill that at-home care to Medicare and Medicaid is set to expire at the end of this month. Craig LeMoult of member station GBH reports.
KETLINE EDOUARD: Hello.
SHANE MCMAHON: Hello.
CRAIG LEMOULT, BYLINE: Shane McMahon arrives at a home in Walpole, Massachusetts, carrying a bag of medical equipment. He's a paramedic with the hospital-at-home program run by Mass General Brigham. His patient here is 91-year-old Stephanie Joseph, who speaks Haitian Creole. Her daughter, Ketline Edouard, translates for her mom and answers questions.
MCMAHON: How is she feeling today?
EDOUARD: She says she's feeling better.
MCMAHON: Better?
EDOUARD: Yes.
MCMAHON: Excellent.
LEMOULT: Joseph has diabetes and recently went to the emergency room because of high blood sugar. After a night there, she was given the option of being part of this hospital-at-home program.
STEPHANIE JOSEPH: (Speaking Haitian Creole).
LEMOULT: She says she's much happier here.
EDOUARD: She feel way, way better, more comfortable when she's home, way better than when she's at the hospital.
LEMOULT: There are now 378 hospital-at-home programs like this in 39 states. The programs began during the pandemic, when the federal government provided a waiver allowing Medicaid and Medicare to pay for hospital-level care at patients' homes. The waiver has been extended once.
MCMAHON: Can I see your finger?
LEMOULT: McMahon puts an oxygen monitor on Joseph's finger and a blood pressure band on her arm.
MCMAHON: And we'll get your pulse ox and your blood pressure, and then I'll take your temp and listen to your lungs and...
LEMOULT: Heather O'Sullivan runs Mass General Brigham's hospital-at-home program and says this is not the same thing as traditional home health care.
HEATHER O'SULLIVAN: The two services are very different.
LEMOULT: The usual home health model involves a few visits a week for about a month. Hospital-at-home programs offer far more intensive care, usually for about five days, including several visits a day from a doctor, nurse or EMT and 24-hour virtual monitoring of patients. O'Sullivan says they can care for 70 patients at home, expanding the hospital's capacity.
O'SULLIVAN: So if you just think about a 70-bed hospital, which is what we operate today, think of what that would look like in a traditional brick-and-mortar setting, how many floors, how many buildings, the workforce required for that.
LEMOULT: The union National Nurses United has raised some concerns about the safety of caring for patients outside of a hospital setting. But a study of hospital-at-home programs conducted last year by the Centers for Medicare and Medicaid Services said patients in these kinds of programs have lower mortality rates and higher satisfaction than at brick-and-mortar hospitals. Other studies have shown the cost is comparable to hospital care. Dr. Constantinos Michaelidis is the medical director of the hospital-at-home program at UMass Memorial Medical Center in Worcester. He's worried about the waiver expiring.
CONSTANTINOS MICHAELIDIS: So we would see much higher rates of inpatient boarding. We would see our emergency departments even more flooded by patients requiring care and not able to receive the care in their brick-and-mortar. And we would see a reversion to the capacity crises that we haven't seen since the COVID days.
LEMOULT: Rachel Jenkins of the American Hospital Association says they've been lobbying Congress to pass a five-year extension of the waiver.
RACHEL JENKINS: To allow for that stability within the program so that, you know, those who are currently operating those programs know it's continuing, can build up and grow in those five years.
LEMOULT: And, she says, so other hospitals can have confidence in starting their own programs. A five-year extension of the waiver is included in the year-end spending bill that Congress is working on this week in an effort to avert a partial government shutdown. Congressman Jim McGovern, a Democrat of Massachusetts, says he'd like to see that in the final version that passes into law.
JIM MCGOVERN: I'm hopeful that there will be an extension. I just - this place doesn't operate like it should. I hate to say that, but that's the reality. And we probably won't know until the very last minute.
LEMOULT: And the very last minute is fast approaching.
For NPR News, I'm Craig LeMoult in Boston. Transcript provided by NPR, Copyright NPR.
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