In the last issue (January/February 2022), there were some very interesting advanced hospital home care options being trialed around the country. This Editorial talks more about the backstory: What are the legislation and demographics behind this trend? As stated in that Editorial, COVID-19 had much to do with this trend. Hospitals were full, but care was still sorely needed. Video care expanded and kept the patients at home until there could be no other option.

Also, during this time, regulatory and legislative pushes were enacted to strengthen the pilots for advanced health care at home (ACH). The ACH model may be partially supported by the expansion of the Home Health Reimbursement Model. Although it is not entirely the same as with ACH, care is in the home in lieu of in the hospital.

The bottom line is that the vast majority of older Americans want to age in place. "Choose Home" is legislation designed to give nursing home-eligible Medicare beneficiaries more options for how and where they recover following a hospital stay. If enacted, "Choose Home" would make "extended care services" as an add-on to the existing Medicare home health benefit for a 30-day window. Examples of extended care services include personal care support, meals, nonemergency transportation, and remote patient monitoring (which is a bit of a hybrid of home health and ACH). This may give many patients the option to go home with enhanced services, rather than to a skilled nursing facility.

In a survey based on a national sample of 2,200 adults, it was found that a vast majority of Americans support greater access to health care services in the comfort and safety of their own homes. As Congress continues to consider the "Choose Home Care" Act, it will be critical to ensure that the needs of Medicare beneficiaries and their families are being met in today's changing health care landscape. Nine in 10 of the Medicare beneficiaries who took part in the survey said they would prefer to receive post-hospital short-term health care at home. Just 3% said they would prefer post-hospital nursing home care (Holly, 2021).

Admittedly, this CMS initiative that seeks to expand home health care is not at the acute level of ACH. In ACH, there is a portfolio of initiatives that harness the power of data and technology to transform health care; patients can receive 24/7 access to acute care providers through an audiovisual module. Under the direction of a physician team, patients receive skilled nursing care, remote monitoring, and other essential services from a network of emergency medical technicians, nurses, and medical technicians.

One patient went home to recover after an autologous bone marrow transplant. Advanced care at home equipped her with a tech pack that included secure, HIPAA-compliant Wi-Fi; blood pressure monitors; any needed medical supplies; a tablet that provides 24/7 virtual connection to Mayo Clinic experts; and a "life alert" device that looks like a watch and can initiate an emergency two-way voice communication with the command center. Everything is set up, connected, and tested, and the patient receives a physical examination to ensure the transfer was safe and successful. She was able to be at home with her family for 14 days, rather than to be in the hospital (Mayo Clinic Magazine, 2021).

An analysis from health economics firm Dobson DaVanzo & Associates found that the "Choose Home Care" model would generate as much as $247 million in annual savings to the Medicare system, with the bulk of that coming from averted skilled nursing facility stays. If enacted, the model would lead to savings of up to $2.8 billion over 10 years, according to the analysis (Holly, 2021).

As the number of homebound adult 70 years and older exponentially increase, it is felt that this expansion of the current home care services can improve quality, reduce health care spending, improve patient mental health, and reduce hospital readmission rates (Eggers, 2021). In a world that now talks about long-term COVID-19, which may extend to the younger population, care in the home is essential.

But according to some, shortcomings have come to the surface:

First, to be relevant for real-world use after the public health emergency, the payment model must reflect data that capture the long-term impact of the pandemic, which is expected to be substantial. Unfortunately, the model is being built using data from 2017 through 2020 that precede the major post-acute care payment reforms in 2020, as well as the COVID-19 pandemic (Hoppe, 2021).

Another flaw is the model's reliance on key data elements that are inconsistently defined across the four settings and even within each setting; these settings include long-term care hospitals, inpatient rehabilitation facilities, skilled nursing facilities, and home health agencies. This prevents cross-setting comparisons of diagnoses, case-mix levels, treatment needs, and costs of care (Hoppe, 2021).

And there is another-very real-danger: the shortage of health care and home aide staff, and the current shortage of health care medical equipment (ever walkers in my part of the country), and medications. It is frightening as it won't matter how patient-centered, creative, and lifesaving these pilots are, it will still take nurses, case managers, pharmacists, physical/occupational/speech therapists, aides, and technology to make it all work ... at least for now. I will throw it back to you, the Reader. What innovative ways have you used to keep staff and supplies available? PCM journal would like to hear from you.

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