Maryland to potentially expand home-based hospital care services

A home-based health care program could soon be incorporated into the Maryland All-Payer Model, with a goal of reducing unnecessary expenditures on hospital services. The Maryland Health Care Commission (MHCC), which helps promote strategies to increase health care affordability in the state, convened last week to discuss the program’s implementation.

 

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The Hospital at Home program, originally conceived by researchers at Johns Hopkins School of Medicine and Public Health, would provide certain patients with the option to receive acute-level care within their home, instead of at a hospital. Eligible patients would include those diagnosed with congestive heart failure, urinary tract infections, and pulmonary embolism, according to criteria from Hopkins.

Research from Hopkins found that the program resulted in patients with better health outcomes and reduced hospital costs by 19%-30%, compared to traditional inpatient care. The program has been adopted by hospitals in at least 10 other states, and payers such as BlueCross BlueShield, Cigna, and Kaiser Permanente have supported similar programs. 

To adopt the Hospital at Home program in Maryland, a Joint Commission’s Report from the state legislature in 2021 directed the Health Services Cost Review Commission (HSCRC) and MHCC to do the following: 

  • Determine the efficacy of the Hospital at Home model
  • Identify existing state regulations that would prevent the implementation of the program into the state’s All-Payer Model
  • Research cost impacts to public and private payers
  • Provide recommendations to implement the program, if approved

The HSCRC recently found no significant regulatory barriers under the All Payer Model to the program’s implementation. It identified two areas of concern that would potentially require a new program to obtain a certificate of need (CON) from the hospital before implementation. The first involved the supply of hospital beds. 

Paul E. Parker, director of the Center for Health Care Facilities Planning and Development, who presented the program to MHCC members, concluded that any fluctuation in hospital bed capacity from patients who are directed into the Hospital at Home Program would not require a CON. 

“This is really not anything like what is envisioned in the law as far as regulatory oversight by the commission. [MHCC IS] a regulatory body that considers the need for capital investment by hospitals, and this is not a program that would be analogous to that in any way. In fact, to the extent that this sort of model is successful in Maryland in actually diverting patients away from the hospital, it actually will reduce demand for hospital bed capacity.”

The second condition that could require a CON would be if the program’s capital expenditure exceeded either $50 million or 25% of the hospital’s annual budgeted revenue. Parker determined that the program would not exceed this cap.

MHCC members unanimously voted to adopt the implementation of the Hospital at Home program within the All Payer Model. MHCC members will now engage in a broader discussion about how the program could be implemented into hospitals, including how patients will be chosen to participate and which agencies will track hospital cost reductions.