Government shutdown imperils hospital at home, telehealth programs
Because Congress didn’t extend waivers for the federal initiatives, reimbursement is at risk and providers are winding down programs.
The shutdown of the federal government over the political stalemate on healthcare funding is putting at risk two of the programs that healthcare organizations have looked for to cost-effectively handle capacity issues.
The shutdown, expected to reach 15 days on Wednesday, is jeopardizing the ongoing use of acute care at home programs as well as funding for telehealth initiatives. Proponents of each approach are sounding the alarm over their futures.
The shutdown – and concurrent Congressional inaction on all other legislation – has resulted in the expiration of Medicare’s Acute Hospital Care at Home (AHCAH) initiative. The latest extension for the program was September 30, and proponents say that without reauthorization, hospitals and patients face uncertainty about its future.
That extension also impacts reimbursement for telehealth services, raising the potential for confusion about the program and possible hesitancy to use it, jeopardizing continuity of care for patients, supporting organizations say.
Hospital at Home programs and telehealth-enabled virtual health services were widely used during the COVID pandemic to safely handle capacity issues, freeing up services for patients with critical issues. Now, providers count on these options to reduce strain on facilities and offer cost-effective venues for care.
Federal guidance and funding are important because commercial payers follow Medicare’s lead. Absent a congressional extension, other payers are left flying blind.
Hospital at Home program lapses
To deal with capacity issues during the pandemic, federal agencies gave hospitals waivers that enabled them to stand up programs to offer acute care to patients in their homes. The waiver for the program expired in 2023 but has been extended several times. But when Congress didn’t pass a continuing funding resolution by September 30, the hospital at home waiver lapsed without renewal.
As a result, the Centers for Medicare & Medicaid Services instructed hospitals to return patients to brick-and-mortar inpatient facilities and stopped accepting new waiver requests, according to information from the Bipartisan Policy Center (BPC). That decision affects hundreds of hospitals – as of September, CMS had approved programs at 419 hospitals across 39 states, although not all operated programs, BPC data show.
The CMS guidance suggested that hospitals that continued Hospital at Home (HAH) programs would no longer be in compliance with a physical environment requirement and would need to submit a formal plan of correction within 60 days.
Some healthcare organizations foresaw challenges in September and had stopped admitting patients to HAH programs. Still, some are treating patients at home who were covered by other payers or Medicare Advantage programs.
For example, an October 14 article by Politico noted that executives at “UMass Memorial Health, the largest health system in central Massachusetts, said they’ve paused the program at their flagship UMass Memorial Medical Center and brought patients back into the hospital. A week into the shutdown, they were already seeing the number of people waiting for a bed creep upward, from around 50 to nearly 70.”
“We are particularly concerned as we go into the winter, where we see a higher number of flu and RSV and COVID cases, where hospitals typically get busier,” said Memorial Health medical director Constantinos Michaelidis in the Politico article.
“This waiver lapse reinforces BPC’s recommendation and BPC Action’s call for Congress to extend AHCAH for five years,” the organization said. “The Hospital Inpatient Services Modernization Act, a bipartisan bill introduced in the current Congress, would provide this extension. A waiver extension (would) recognize new advancements in technology, such as remote patient monitoring.”
Telehealth program challenges
Lapsed extensions also are affecting Medicare telehealth “flexibilities,” contends ATA Action, the advocacy arm of the American Telemedicine Association.
The lobbying initiative contends that the lapse of the extension enabling federal coverage of telehealth services could cause other payers to waver in their commitment to pay for this form of virtual care.
“With the lapse of the Medicare telehealth flexibilities, there is growing uncertainty in the marketplace, and concern that commercial payers could soon follow suit if Congress and the Administration do not act quickly,” a statement from ATA Action suggests. “The result is a climate of confusion and hesitation that threatens the continuity of care for millions of Americans.”
ATA Action noted that most commercial payers are still offering coverage for virtual care services to beneficiaries “unimpeded during this temporary lapse in Medicare telehealth flexibilities.”
The lapse of waivers is a worrying source of uncertainty, the organization contends. The “absence of clear federal policy is disrupting care and creating anxiety across the healthcare system, which is already impacting patients and providers,” it noted in a statement.
“We’re hearing from many hospitals and healthcare systems that they are continuing to provide telehealth services to Medicare patients during the shutdown, hoping they will receive retroactive reimbursement once the government reopens,” said Kyle Zebley, executive director of ATA Action and senior vice president of public policy at the ATA.
Zebley said he appreciated the decisions of commercial insurers to continue telehealth coverage but said he worries about the effects of a prolonged delay on the federal waiver. “As Medicare reimbursement goes, so often goes commercial coverage, forcing providers to make difficult choices about sustaining virtual care,” he added. “The impact on healthcare delivery, and on patients’ well-being nationwide, is deeply concerning.”