CHAP Community Grand Rounds with Dr. Khai Nguyen (Course 1: An Inconvenient Care) 

CHAP Community Grand Rounds is a FREE, on-demand CEU program designed specifically for Nurses and Physicians who deliver care in the home and community.

Dr. Khai Nguyen walks you through the aging imperative we are faced with through the lens of a patient and a population explaining how inconvenient care can become convenient by using the 4 M’s framework of age-friendly care. The purpose of this activity is to educate medical practitioners working in community-based care on the importance of Age Friendly Care.

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Hospital At Home Is Not Just For Hospitals

Health Affairs | By Pamela Pelizzari, Bruce Pyenson, Anna Loengard, Matthew Emery
 
Hospital at Home programs deliver needed services to appropriate patients in their homes and can effectively serve patients, payers, and providers. The programs provide physician visits, drugs, monitoring, nursing services, diagnostics, and other services at a level typically reserved for patients in inpatient settings. A typical Hospital at Home patient has features that make home care preferable, for example, they may present to an emergency department with uncomplicated, simple pneumonia, have no significant comorbidities, and live with a partner who can provide basic care, such as preparing meals. Studies have shown these programs have lower readmission rates, lower payer costs, and higher patient satisfaction. Patients prefer their homes, payers prefer having patients get care in the least acute setting possible, and hospital providers want to have beds available for patients who need them.
 
While Hospital at Home programs have been studied since the 1970s, adoption had been slow until the COVID-19 public health emergency (PHE) prompted the Centers for Medicare and Medicaid Services (CMS) to waive the Medicare Hospital Conditions of Participation to enable the use of this care delivery model for Medicare beneficiaries. In 2020, CMS implemented the Acute Hospital Care at Home Waiver, which establishes Medicare payment for home hospitalizations. The combination of the PHE and CMS’s regulatory response has generated huge demand for Hospital at Home. By July 2021, eight months after the Acute Hospital Care at Home Waiver program was established, more than 140 hospitals across 66 health systems were approved by CMS to provide hospital services in a home setting. Because of COVID-19, patients and providers have quickly embraced telehealth, and that “stay at home” attitude may bring Hospital at Home into the mainstream. In 2019, the Medicare population had more than 800,000 hospitalizations, which could have qualified for Hospital at Home. As the care delivery model grows in the post-PHE, some important questions remain, such as how insurers will reimburse providers for Hospital at Home services and the types of provider organizations that will embrace this novel care delivery model.
 
Top-Down And Bottom-Up Payment Approaches
 
Medicare currently pays for Hospital at Home using a top-down (hospital-centered) payment—the payment is made to hospitals, and the amount is based on Medicare’s payment system for acute inpatient admissions. An alternative, bottom-up approach could generate a payment amount on the basis of existing home-based care payment systems, with additions for the expanded services needed for the more acute patients in a Hospital at Home model. Because home care providers are typically reimbursed at lower rates, this approach to payment would be less expensive and could capitalize on the existing in-home care expertise these providers have, while expanding their reach to a higher-acuity patient population. The co-authors have compared payment options for home hospitalization programs under both the top-down and bottom-up approaches.

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CMS Updates Guidance Related to Emergency Preparedness R/T the Ongoing PHE

From CHAP

CMS’s Quality, Safety & Oversight Group posted Revised Memo on May 26, 2022, which provides updated guidance for surveyors and providers about emergency preparedness training and testing program exemptions and assessment of compliance with the EP requirements. (Guidance related to Emergency Preparedness- Exercise Exemption based on A Facility's Activation of their Emergency Plan (Ref: QSO-20-41-ALL, Revised 5/26/2022))

This updated guidance only applies if a facility/provider is still currently operating under its activated emergency plan or reactivated its emergency plan for COVID-19 in 2021 or 2022.

If your organization has resumed normal operating status (not under their activated emergency plans), you are required to conduct testing exercises based on the regulatory requirements for their specific provider or supplier type. 

Background: The emergency preparedness regulations allow an exemption for providers or suppliers that experience a natural or man-made event requiring activation of their emergency plan. On Friday, March 13, 2020, the President declared a national emergency due to COVID-19 and subsequently many providers and suppliers have activated their emergency plans to address surge and coordinate response activities. Facilities that activate their emergency plans are exempt from the next required full-scale community-based or individual, facility-based functional exercise. Facilities must be able to demonstrate, through written documentation, that they activated their program due to the emergency.

Updated guidance key points:

• CMS recognizes many facilities are still operating under disaster/emergency conditions during the PHE, (e.g., under an activated emergency plan), so they are providing additional guidance for inpatient and outpatient providers/suppliers, consistent with the exemption authorized by the EP regulations. 
• This guidance provides clarifications on testing exemptions for those providers/suppliers who continue to operate under their activated emergency plan and those which may have reactivated their emergency plans for COVID-19. 
• This exemption applies to the next required full-scale exercise only, not the exercise of choice, based on the facility's 12-month exercise cycle. 
  • The exercise cycle is determined by the facility (e.g., calendar year, fiscal year or another 12-month timeframe).

This guidance will also apply for any subsequent 12-month cycles in the future, in the event facilities continue to operate under their activated emergency plans for COVID-19 response activities.

Monkeypox Virus Infection in the United States and Other Non-endemic Countries—2022

Cases of monkeypox have previously been identified in travelers from, or residents of, West African or Central African countries where monkeypox is considered to be endemic. CDC is issuing this Health Alert Network (HAN) Health Advisory to ask clinicians in the United States to be vigilant to the characteristic rash associated with monkeypox. Suspicion for monkeypox should be heightened if the rash occurs in people who 1) traveled to countries with recently confirmed cases of monkeypox, 2) report having had contact with a person or people who have a similar appearing rash or received a diagnosis of confirmed or suspected monkeypox, or 3) is a man who regularly has close or intimate in-person contact with other men, including those met through an online website, digital application (“app”), or at a bar or party. Lesions may be disseminated or located on the genital or perianal area alone. Some patients may present with proctitis, and their illness could be clinically confused with a sexually transmitted infection (STI) like syphilis or herpes, or with varicella zoster virus infection. Read the full report at Monkeypox Virus Infection in the United States. 

Additional information on Monkeypox can be found here: Monkeypox | Poxvirus | CDC