Expanding the use of telehealth may be one of the pandemic’s silver linings. The Mayo Clinic and Kaiser Permanente have just announced a joint $100m investment in Medically Home. The organization’s purpose is to “Enable health systems to safely bring the virtual hospital home.”
This is important because telehealth, including hospital at home, enables medical care to reach people who might otherwise go untreated. But uneven, often inadequate reimbursement levels puts the silver lining at risk.
The Virtual Hospital
The hospital at home arrangement isn’t for all patients. Medically Home’s system is intended for acute care patients with serious or complex illnesses; such as, cancer care, transfusions. and worsening chronic disease.
Their virtual hospital includes technology to see and monitor the patient, availability of a rapid response paramedic and nurse, and necessary medical equipment. The patient also has a phone that allows the patient and family members immediate access to a clinical team.
Safety is another key component of hospital at home programs. That means ensuring the patient receives safe, quality care and has a safe home that supports their at-home treatment.
Benefits of Hospital at Home
Hospital at home isn’t new. Johns Hopkins has been operating their hospital at home model since 1994. According to the Commonwealth Fund, a 2001/2002 study found that Hopkins’ hospital at home services reduced costs by 32 percent, shortened the mean length of stay by one-third, and increased patients and family members’ satisfaction.
Despite these positive outcomes, expansion of hospital at home care has been slow. That’s due in no small part to the lack of adequate reimbursement by insurance providers and the Centers for Medicare and Medicaid Services (CMS). That changed last year when the pandemic hit.
Pandemic’s Silver Lining
The pandemic resulted in over-crowded hospitals, medical professionals unable to reach people in rural areas, and people’s refusal to be hospitalized for non-COVID issues. Those issues highlighted the urgent need for different health care delivery models. Telehealth was the answer.
Suddenly some of the barriers to widespread use of telehealth services went away. A big improvement was the change in reimbursement rates. CMS and most private insurers agreed to “payment parity” for telehealth visits. That means reimbursement rates for telehealth visits will equal those paid for in-person visits. But the change was approved for use only during the pandemic. That takes us to future challenges and choices.
Hospital at Home Reimbursement Choices
According to the Kaiser Family Foundation, prior to the pandemic, growth of telehealth was limited due to a “…lack of uniform coverage policies across insurers and states.” States and insurance plans had different payment levels. But the payments were almost always less than those for in-person care.
As I mentioned above, the “payment parity” rules are due to expire at the end of the pandemic. What will happen then? To help ensure adequate payment, the Mayo Clinic is only offering hospital at home through Medicare Advantage plans they have a contract for and their own insurance product. Since Kaiser Permanente is both provider and insurer, they also have similar payment protection.
Unfortunately, individual strategies like the Mayo Clinic’s and Kaiser’s don’t resolve the larger reimbursement issue. In order for the expansion of telehealth care to be a true silver lining, reimbursement rates need to be permanently set at payment parity levels. The choice to do so is up to government payers like Medicare, insurance companies, and legislators. Let’s see what choices they make.