A rise in patient acuity over the next decade will create an even greater strain on hospitals’ resources, according to a report released Tuesday by Vizient and its subsidiary Sg2. Acuity is defined as the measurement of a patient’s severity of illness and the intensity of care required.
The rise in acuity, fueled by an increase in Americans requiring inpatient chronic condition care, will outpace inpatient volume and increase patients’ length of stay. The report predicts hospitals’ adult inpatient volumes will recover from pre-pandemic levels but grow only 2% over the next decade. However, adult inpatient days are expected to rise by 8% during the same time, and tertiary inpatient days — which refers to patients who need highly specialized medical care —are expected to grow by 17%.
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Longer inpatient stays will exacerbate hospitals’ capacity constraints, so they may need to fundamentally restructure their care delivery models.
“While case mix varies by hospital, it is likely this combination of increased inpatient volume, patient complexity and length of stay may require healthcare organizations to rethink service line prioritization, service distribution and investment in care at-home initiatives,” said Dr. Maddie McDowell, senior principal and medical director of quality and strategy for Sg2.
Delivering more care in patients’ homes will help alleviate the projected strain on hospital capacity. The report predicted 19% growth for home evaluation and management visits, 13% growth for home hospice and 10% growth for home physical and occupational therapy. Growth was also projected for home minor procedures, home nurse visits and home chemotherapy.
However, CMS has not yet decided on a permanent reimbursement status for a key type home care: hospital-at-home programs.
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CMS approved these programs, which allow hospitals to provide patients acute-level care in their own homes, for temporary reimbursement during the pandemic through its Acute Hospital Care At Home waiver program. The program has been widely utilized since its introduction in 2020, with 103 systems, comprising 237 hospitals across 36 states, currently taking part, according to CMS data last updated June 1.
Despite high levels of use, CMS’ hospital-at-home waiver program is set to expire when the federal Covid-19 public health emergency ends. But this coverage needs to be made permanent to address the incoming rise in patient acuity, the report said.
In March, a group of four congressmen introduced the bipartisan Hospital Inpatient Services Modernization Act, which would extend CMS’ waiver program two years beyond the public health emergency’s expiration date. The bill has earned support from the American Hospital Association, which said such an extension would help hospitals care for more patients.
The AHA said hospital-at-home programs “continue to be reliable and impactful vehicles to deliver effective care, lead to high patient satisfaction, and, for some patients, result in shorter recovery times.” The organization said it is willing to work with Congress and CMS to establish a permanent version of the program, as the care modality frees up hospital beds and often improves patient experiences.
McDowell noted that “while scalability for care at home is difficult”, hospitals will need to prioritize care redesign efforts sooner rather than later to avoid being blindsided by growing patient acuity.
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