The popular 'hospital-at-home' effort is at stake in the federal spending battle

Shane McMahon, a paramedic, checks on Stephanie Joseph, 91, who received care through Mass General Brigham's hospital-at-home program. Craig LeMoult/GBH hide caption

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Craig LeMoult/GBH

Shane McMahon arrived at a home in Walpole, Massachusetts carrying a bag of medical equipment. He's a paramedic with the hospital-at-home program run by Mass General Brigham. His patient was 91-year-old Stephanie Joseph.

"How is she feeling today?" McMahon asked Joseph's daughter, Ketline Edouard, who translated for her Haitian Creole-speaking mom.

"She says she's feeling better," Edouard replied.

Joseph has diabetes and recently went to the emergency room because of high blood sugar. After a night there, she was given the option of being part of Mass General Brigham's "Home Hospital" program.

"She says way better, more comfortable when she's home," Edouard said on her mom's behalf. "Way better than when she's at the hospital."

There are now 378 hospital at home programs like this in 39 states. These programs began during the pandemic when the federal government provided a waiver allowing Medicaid and Medicare to pay for hospital-level care at patients' homes. The waiver's been extended once. But the current waiver is set to expire on December 31.

A five-year extension of the waiver is included in a spending agreement congress unveiled this week to avert a government shutdown, but Elon Musk and President-elect Donald Trump encouraged Republicans to walk away from that deal Wednesday. It is not clear what will happen next with the stopgap spending measure.

Hospital-at-home programs are not the same thing as traditional home health care. The usual home health model involves a few visits a week for about a month. Hospital-at-home programs offer far more intensive care, usually for about five days, including several visits a day from a doctor, nurse or emergency medical technician and 24-hour virtual monitoring of patients.

Mass General Brigham's hospital-at-home program can care for up to 70 patients, expanding the hospital's capacity, said Heather O'Sullivan, who runs the program.

"So if you just think about a 70-bed hospital, which is what we operate today, think of what that would look like in a traditional brick and mortar setting – how many floors? how many buildings? the workforce required for that," O'Sullivan said.

The union National Nurses United has raised some concerns about safety of caring for patients outside of a hospital setting. But a study of hospital-at-home programs conducted last year by the Centers for Medicare and Medicaid services said patients in these kinds of programs have lower mortality rates and higher satisfaction than brick and mortar hospitals. Other studieshave shown the cost is comparable to or lower than hospital care.

Dr. Constantinos Micaelidis is the medical director of the hospital-at-home program at UMass Memorial Medical Center in Worcester. He's worried about the waiver expiring.

"We would see much higher rates of inpatient boarding," Michaelidis said. "We would see our emergency departments even more flooded by patients requiring care and not able to receive the care in their brick and mortar. And we would see a reversion to the capacity crises that we haven't seen since the Covid days."

The American Hospital Association has been lobbying Congress for an extension.

"We're advocating for them to extend the waiver for five years to allow for that stability within the program so that those who are currently operating those programs know it's continuing, [and] can build up and grow in those five years," said Rachel Jenkins of the American Hospital Association.

The Medicare and Medicaid waiver that makes the hospital-at-home program possible expires on Dec. 31, 2024. Congress could extend it. Stephanie Joseph's daughter, Ketline Edouard, helps paramedic Shane McMahon care for her mom. Craig LeMoult/GBH hide caption

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Craig LeMoult/GBH

And, she said, so other hospitals can have confidence in starting their own programs.

Rep. Jim McGovern, a Democrat of Massachusetts, says he'd like to see that the five-year extension of the program the final version of a federal spending agreement.

"I'm hopeful that there will be an extension," McGovern said, noting political hurdles in congress. "This place doesn't operate like it should. I hate to say that, but that's the reality. And we probably won't know until the very last minute."

And the very last minute is fast approaching.