Home heart hospital linked to enhanced outcomes, lower costs

A home heart hospital that provides hospital-level at-home care was associated with improved quality and reduced healthcare spending for high-need and high-cost patients with cardiovascular disease (CVD), according to recent research.

Hospital-at-home programs have grown in the last few years, spurred by the launch of the Centers for Medicare and Medicaid Services (CMS) Acute Hospital Care at Home waiver in 2020. Hospitals approved for the waiver are exempt from certain Medicare conditions of participation, allowing them to provide inpatient-level care in patient homes. As of June 18, 331 hospitals in 37 states have been approved for the waiver.

In the new study, researchers examined whether a similar model could provide enhanced care for high-need and high-cost CVD patients. The home heart hospital is like a hospital-at-home model but differs in some ways. According to the study authors, the hospital-at-home model focuses on managing patients through acute care episodes, while the home heart hospital is designed to manage patients intensively at home for weeks or months to manage acute illnesses and enable “whole-person health and condition management.”

The researchers used insurance claims and EHR data to evaluate the annual hospitalization rates, care costs, and mortality rates among CVD patients before, during, and after home hospital care.

Between February 2019 and October 2021, 94 patients were admitted to the home heart hospital. The patients were over 18, had three or more chronic conditions, including one CVD, and had at least two hospitalizations in the prior year where CVD was a significant contributing factor.

Of the 94 patients, 50 percent had congestive heart failure, 37 percent had atrial fibrillation, and 44 percent had coronary artery disease.

The researchers evaluated outcomes by grouping the data into three time periods: the conventional care period, which spanned 180 days before home heart hospital enrollment; the home heart hospital enrollment period, which began with enrollment and ended at discharge; and the post-home heart hospital period, which included the 180 days following discharge. Patients spent an average of 80 days enrolled in the home hospital program.

The study shows that the home heart hospital period was associated with 2.4 fewer admissions per patient-year and a 57 percent absolute risk reduction for hospitalization than the conventional care period. Additionally, enrollment in the home heart hospital was associated with a 20-day decrease in annualized length of stay per patient-year compared to the conventional care period.

Five patients died while enrolled in the home heart hospital, resulting in a 5.3 percent mortality rate, which “is comparable in magnitude and pattern [to] previously published estimates of inpatient outcomes among HNHC [high-need, high-cost] populations, which have estimated in-hospital mortality at 3 percent,” researchers noted.

Enrollment in the home heart hospital was also associated with a $56,990 reduction in the total cost of care per patient and a $78,210 decrease in Medicare Part A costs per patient.

Further, annualized post-home heart hospital total costs and part A costs were $113,510 and $84,480 lower, respectively, than conventional care costs.

Thus, researchers concluded that “longitudinal home-based care models hold promise for improving quality and reducing healthcare spending for HNHC [high-need, high-cost] patients with CVD.”

The research aligns with prior studies showing positive outcomes associated with hospital-at-home care.

A CMS study published last year shows that patients receiving at-home hospital care under the Acute Hospital Care at Home waiver experienced a low mortality rate and minimal complications. The researchers examined patient outcomes at the 277 hospitals with approved waivers as of March 20, 2023. A total of 11,159 patients received care under the waiver.

The study revealed that 7.20 percent of patients were transferred from home to the hospital to complete their care. Only 38 unexpected deaths (0.34 percent) occurred in participating hospitals, with most occurring among COVID-19 patients that progressed to more severe illness symptoms.