Mass General Brigham to Expand Hospital-at-Home Services

Mass General Brigham is expanding its hospital-at-home program to three community hospital sites in Massachusetts: Brigham and Women's Faulkner Hospital, Newton-Wellesley Hospital, and Salem Hospital.

The Centers for Medicare and Medicaid Services (CMS) and the Massachusetts Department of Public Health recently authorized the health system to expand its Home Hospital. Established in 2022, Mass General Brigham's Home Hospital combined the existing hospital-at-home programs at Massachusetts General Hospital and Brigham and Women's Hospital.

Hospital-at-home programs provide patients with acute-level care at home. While these programs date back decades, hospital-at-home efforts received a significant boost in November 2020 when CMS launched the Acute Hospital Care at Home waiver. Hospitals approved under the waiver are exempt from the Medicare Hospital Conditions of Participation and can provide care for Medicare beneficiaries at home. These hospitals are reimbursed at inpatient rates.

As of August 24, 296 hospitals spanning 37 states have been approved for the waiver, including Mass General Brigham.

The health system's Home Hospital has cared for over 3,000 patients since the approval. This year, nearly 1,000 patients have been admitted to the Home Hospital, which currently can serve 33 patients at a time. The health system plans to expand the Home Hospital's capacity to serve 45 patients daily, according to a press release.

Home Hospital patients receive daily in-home or virtual visits from a nurse practitioner, physician assistant, or physician. The clinicians work in collaboration with a team of paramedics, nurses, therapists, and home health aides. Together, they provide a wide array of services in the home, including intravenous fluids and medication services, laboratory testing, electrocardiograms, and ultrasounds.

The Home Hospital also leverages a continuous remote patient monitoring (RPM) platform that transmits patient vital sign readings to clinicians and enables two-way text and video communication.

"Being able to have that kind of vantage point, you can ensure greater health and safety of a patient as you're tailoring their care plan to their personal environment," said Stephen Dorner, MD, MPH, MSc, chief clinical and innovation officer for Mass General Brigham Healthcare at Home, which includes the Home Hospital, in the press release.

Mass General Brigham will launch Home Hospital operations at Faulkner Hospital, Newton-Wellesley Hospital, and Salem Hospital in mid-September.

Further, the health system plans to shift about 10 percent of inpatient care at Brigham and Women's, Mass General Hospital, Newton-Wellesley Hospital, Salem Hospital, and Brigham and Women's Faulkner Hospital to patient homes over the next five years.

Following the launch of the CMS waiver, hospital-at-health programs proliferated nationwide.

Earlier this year, Atrium Health struck a three-year partnership with Best Buy Health to create new home-based acute care offerings and enhance its hospital-at-home program. Through the partnership, the organizations will co-design new hospital-at-home care capabilities. Atrium Health patients will also gain access to Best Buy Health's at-home care platform, Current Health.

Similarly, VCU Health implemented a hospital-at-home program in January. The program, which aims to expand care access without necessitating travel and in-hospital stays, is available to patients with heart failure, pneumonia, and sepsis.

But the future of hospital-at-home services in the United States is uncertain. Currently, the CMS waiver is only extended through December 31, 2024.

However, healthcare providers are rallying to extend access to hospital-at-home services. In 2021, Mayo Clinic, Medically Home, and Kaiser Permanente launched the Advanced Care at Home Coalition to advocate for the model and work to address regulatory and legislative barriers. The coalition includes several prominent health systems, including Adventist Health, ChristianaCare, and Geisinger health system.