Utah Huntsman Cancer Institute calls for easing of home-based hospital care regulations to continue oncological treatment for rural patients

The University of Utah Health (U of U) Huntsman Cancer Institute’s Huntsman at Home (HH) program has been providing a full spectrum of care to acutely ill cancer patients in the home setting since 2018. 

 

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HH administrators say during the course of their treatment, oncological patients are more likely to develop acute symptoms that require hospitalization and emergency room visits. The home care program focuses on providing prevention and comfort to patients to mitigate this.

Incorporating the CMS hospital care at home model, the program aims to improve the experiences of cancer patients by managing acute conditions that would normally be treated in the hospital through coordinated care at home. To date, HH has taken care of over 2,000 families, mostly in the Salt Lake region. 

In results published last year, researchers found that the program had reduced hospitalizations and emergency department utilization by 55% and 45%, respectively, while reducing overall costs by 47% and length of hospital stay by an average of 1.1 days over a 15-month period from August 2018 to October 2019. 

Kathleen Mooney, PhD, Professor of Nursing at U of U and Research Director of Huntsman at Home, led the study. She recently told State of Reform that Huntsman has been focused on addressing issues of access and equity in rural areas. 

“When [rural cancer patients] get into trouble, they don’t have a specialist to take care of that acute episode, or people in their community that can help them to prevent those episodes,” Mooney said. “We know that it’s more difficult for rural-dwelling people to access cancer specialty care, and so there is an access issue there that we’re trying to bridge.

There’s also an equity issue … we don’t just want to build out programs that work in Salt Lake. We want to see how we can adapt them and put them into communities at a distance. We have a demonstration project trying to evaluate [rural access and equity] that is in process right now.”

HH has expanded from the Salt Lake Valley to 3 rural counties in Southeast Utah where access to specialty care is nonexistent and travel to the nearest Huntsman clinic poses a challenge for many patients due to distance. 

While the Huntsman Cancer Institute has a plan to scale the program to other areas of the state, Mooney said the program’s lack of a reimbursement model restricts expansion. 

“Cancer care, as well as a lot of other chronic disease care, does not have a home-based delivery model,” Mooney said. “The model of care is hospitalization as needed, and clinic visits to manage the condition. There isn’t home-based care, certainly not acute care that is substituting for a hospitalization or home-based care that substitutes for an emergency department evaluation. 

The challenge for a hospital at home model is how to be reimbursed because reimbursement for home health visits is really episodic [and for] non-urgent care, and is not something that is sustainable. It isn’t equivalent. The hospital at home programs are more like a hospital program than they are like our home health program.”

Along with reimbursement, Mooney says current regulations address delivery of care only in a hospital or through a clinic and not the home. She advocated for policies that ease the regulatory barriers of providing cancer care in the home.

Officials from the Huntsman Cancer Institute met with Governor Spencer Cox and members of his cabinet earlier this month to discuss looking at ways to support and facilitate the program. Administrators have also been engaged with Regence Blue Cross Blue Shield of Utah about what an appropriate payment model would look like for the sustainability of home-based cancer care. According to Mooney, those discussions are in the very early stages of potential policy development. 

CMS recently renewed its Medicare waiver for hospital care at home, which was originally initiated in November 2020 during the Public Health Emergency (PHE), for an additional 90 days. The extension allows diagnosis-related group payments to be made for home hospital care in place of hospitalization, but is not expected to last beyond January 11th of next year when the PHE is expected to end. 

Congress introduced the Hospital Inpatient Services Modernization Act in March, which was referred to the House Subcommittee on Health and remains under review. If passed, the legislation would direct CMS to continue the hospital care at home waiver for an additional 2 years and develop policies around the provision of broader hospital care at home.