Dive Brief:

• CMS is expanding the ability of hospitals to treat their acute care patients at home ahead of an expected surge in COVID-19 hospitalization following the Thanksgiving holiday, when many Americans ignored public health advice against gatherings.
• The guidance released last week also tweaks earlier changes allowing ambulatory surgical centers to provide greater inpatient care by stating 24-hour nursing services need to be available only when a coronavirus patient is at the center.
• Six health systems were immediately granted waivers for the new Acute Hospital Care At Home program to treat more than 60 acute conditions. CMS said it has been in discussion with other hospitals and expects new applications to be submitted.

Dive Insight:

Public health experts warned this weekend the worst surges of COVID-19 could be in the coming weeks, as community spread is extensive throughout the country as many in the U.S. still traveled to be with family for Thanksgiving.

And hospitals are already stretched to the brink, scrambling to create additional ICU capacity ahead of the expected jump in hospitalizations that typically follows record-high case counts.

The new acute-care at home program builds on the Hospitals Without Walls initiative CMS launched in March, which allowed facilities to provide inpatient services in other buildings like hotels or dorm rooms.

CMS said that under the program, 85 ASCs are providing inpatient care, and it predicts the additional flexibilities just announced will prompt more to enter.

The new guidance focuses on at-home care for conditions that can often warrant a hospital stay, like asthma, pneumonia, congestive heart failure and chronic obstructive pulmonary disease.

Such services existed before the coronavirus pandemic and were growing. Health systems have turbocharged those plans as the COVID-19 crisis continued and telehealth use in general boomed. 

Intermountain Healthcare announced a hospital-at-home service in June and Universal Health Services partnered with Bayada a month later to provide post-acute home care.

At-home care is often preferred by patients, especially during the pandemic when hospital care means friends and family cannot be present. Some research has shown it to be less costly and result in fewer readmissions.

Patients can only be admitted for at-home acute care from an emergency room or inpatient bed, and they will receive at least two in-person visits a day from a registered nurse or paramedic. Hospitals are also required to perform screening for non-medical factors that could impede at-home care like not having working utilities or a risk for domestic violence.

The six health systems participating at launch — Brigham and Women's Hospital in Massachusetts; Massachusetts General Hospital; Hunstman Cancer Institute in Utah; Mount Sinai Health System in New York City; Presbyterian Healthcare Services in New Mexico; and UnityPoint Health in Iowa — cover multiple major metro areas.

The Association of American Medical Colleges applauded the move, but warned capacity isn't the only difficulty hospitals are facing. Healthcare workers are needed to treat patients and operate specialized equipment, but they are facing sickness themselves, along with burnout from the unprecedented requirements.

"Although teaching hospitals are uniquely prepared to deal with public health emergencies, the nation’s health care workforce is stretched thin on the front lines of this pandemic," AAMC wrote.

Although clinicians have learned more about the best ways to treat COVID-19 since the early days of the pandemic, patients often require a hospital stay and can quickly end up in the ICU. Capacity in those wards varies greatly across the country, and hospitals in previous hot spots have found themselves overwhelmed.

This can force a facility to curtail or halt lucrative elective procedures, which some have had to do. That can be a major financial drag for hospitals, which have reported lower volumes as people avoid routine care.

The trend continued in October, as hospitals reported falling volumes and margins amid rising expenses. So far this year, total expenses per adjusted discharge have increased 14% year over year, according to the latest flash report from Kaufman Hall.

And the Jefferies hospital traffic index for last week showed flat volumes — down more than 2% from the post-recovery high — amid rising COVID-19 cases.