Pittsburgh Review

Allegheny Health Network issued the following announcement on Dec. 21.

Allegheny Health Network (AHN) announced that its Home Recovery Care program is expanding to include the region’s fee-for-service Medicare beneficiaries, allowing senior patients who are recovering from a wide range of acute medical conditions to receive advanced treatment at home following an emergency-room visit.

The program, which required the approval of the U.S. Centers for Medicare and Medicaid Services (CMS), will also help to decompress hospitals during the winter months, and help to keep beds free for COVID-19 patients as case numbers increase regionally and nationally.

AHN is among the first health systems in the country to receive the special waiver.

“The expansion of our Home Recovery Care program will allow even more of our Medicare patients to receive safe, acute-level care from the comfort of their own home,” said Monique Reese, Highmark Health, senior vice president of home and community care.

For the last year, AHN’s Home Recovery Care (HRC) team has been providing at-home hospital care to Highmark’s Medicare Advantage plan beneficiaries, as well as to certain non-Medicare patients who receive coverage through Highmark Inc.’s commercial health plans.

Now, because of the waiver, AHN is able to offer the HRC program to Medicare fee-for-service beneficiaries, or those seniors receiving coverage through Medicare Part A and B, also known as Original Medicare. In Pennsylvania, about 40 percent of seniors receive coverage through privately administered Medicare Advantage plans, while about 60 percent use Original Medicare.

“The COVID-19 pandemic has required AHN, like all care providers, to implement a number of restrictions on hospital visitation,” Reese said. “Through the HRC program, our eligible Medicare patients will be able to spend more time at home with family and caregivers. But regardless of eligibility, it is always the patient’s choice whether to receive these services in the home, and patients who prefer a traditional hospital care setting always have that option.”

On Nov. 25, CMS unveiled the new “hospital-at-home” waiver program, which gives pre-approved acute care facilities more freedom to provide — and be reimbursed for — at-home medical and acute-care services. The waiver program is meant to relieve volumes at hospitals during a time when inpatient capacity is severely limited, due to surging COVID-19 levels.

AHN joins several of the nation’s leading hospitals and health systems in getting this waiver, including Brigham and Women’s Hospital (Massachusetts), Huntsman Cancer Institute (Utah), and Mount Sinai Health System (New York City) in offering expanded at-home care options for Medicare beneficiaries.

The CMS waiver is temporary, but AHN and Highmark Health believe the policy provides a solid structural framework for future reimbursement discussions related to home-hospital care for Medicare Part A beneficiaries. Home-hospital care is more intensive than traditional home care services — which typically include skilled nursing, physical therapy, occupational therapy, nutritional counseling, and other services — and requires different levels of reimbursement.

“A significant number of patients, even some with complex or chronic conditions, do not need to be hospitalized if you can care for them at home in a safe, cost-effective way,” said Harshit Seth, MD, system medical director, Hospitalists Services at AHN and medical director, AHN Home Recovery Care. “Through the HRC program, patients can receive a full complement of inpatient hospital services, including our outstanding physician-led care, a registered nurse who’s a dedicated care coordinator, in-home nursing visits, telehealth visits, infusion, and more.”

Through the program, clinically eligible patients who have been seen at Allegheny General Hospital (Pittsburgh), Forbes Hospital (Monroeville), and Jefferson Hospital (Jefferson Hills) can receive home-hospitalization services for common conditions including asthma, cellulitis, congestive heart failure, COPD, dehydration, pneumonia, urinary tract infections, and COVID-19.

When patients come to the emergency department, Home Recovery Care coordinators screen them to see if their conditions can be treated at home. Once at home, patients begin a 30-day episode of care, which may include nurse visits, lab tests, infusion services, oxygen therapy, intravenous antibiotics, wound care, and virtual check-ins with hospitalist physicians. The patients are also monitored through a telehealth station that is left in their home.

AHN’s HRC program was launched through a joint partnership between Highmark Health and Nashville-based company Contessa, which specializes in home health services.

Original source can be found here.