Despite having bipartisan support, the Centers for Medicare & Medicaid Services (CMS) Acute Hospital Care At Home waiver program has been a casualty of the ongoing government shutdown.
However, hospital-at-home operators can’t afford to wait and see what happens. They must remain and push for waiver funding, according to Ray Quintero, managing partner at Washington, D.C.-based health care policy consulting firm Healthsperien.
As a result of the shutdown and the waiver lapsing, CMS issued guidance mandating that all patients be discharged and returned to hospitals.
“That’s unfortunate, of course, it’s a disruption in care,” Quintero said at the Hospital at Home Users Group annual meeting earlier this month. “It also does not provide any sort of relief, or any sort of predictability for those of you that are participating in the program, or anyone who’s considering coming into the model.”
Right now, CMS is no longer accepting waiver requests. Prior to the government shutdown, 147 health systems in 39 states were approved for the CMS waiver program.
At this time, providers should be focused on fighting what Quintero described as a “disruption in care” with facts.
With this in mind, the Hospital at Home Users Group conducted a survey among its members, which found that 88% of health care organizations reported that the waiver expiration impacted their hospital-at-home programs.
Additionally, 67% of those hospital-at-home programs reported a reduction in admissions.
“When you think about impact, that’s huge,” Quintero said. “When we say that 88% of programs were impacted, and these are numbers that really speak, we [heard] recently and continue to hear all the time that a story is just a story without data to support it. Now, we have data supporting what we’re telling Congress and what we will continue telling [them] consistently.”
The Hospital at Home Users Group also promotes Congressional engagement by making an outreach template available to hospital-at-home program operators.
“This template is being used to educate members of Congress, but it also enables [waiver program] participants to make an immediate request to Congress, [urging] them to pass the Hospital Inpatient Services Modernization Act, or just to get the government funding again and to continue the waiver program for whatever period they can now,” he said. “Of course, our goal here is to have the waiver program continue for five years, but in the interim, we at least need the program back up and running.”
Education is another component of the Hospital at Home Users Group’s Congressional engagement efforts. The organization has developed a one-pager that details the benefits of the CMS waiver program and offers Congress evidence to support the case for a long-term hospital-at-home waiver.
Quintero also noted the need to make headway with the Trump administration.
“This is a new administration, even though it’s President Trump’s second administration,” he said. “There are new members, new appointed officials, as well as their staffs, that are coming on board, and are continuing to learn about this important program, and are continuing to be fascinated by the importance of the program.”.
At the beginning of October, the Hospital at Home Users penned a letter addressed to the Department of Health and Human Services (HHS) Secretary Kennedy and CMS Administrator Dr. Oz, detailing the disruption that has resulted from the waiver ending.
“It’s placing additional strain on hospitals and systems,” Quintero said. “It’s creating operational strain. It’s creating financial strain, as well as capacity challenges. We also wanted to reflect in this letter the fact that the Users Group has continued to be … a great partner to CMS, not only providing them with data, [but also] providing them with support and also providing them with firsthand information of how this program is working on the ground.”