Hospital-at-Home Patients Have Lower SNF Admissions

A program to provide hospital care in the home led to lower admissions to skilled nursing facilities for the patients who took part in it, a June 25 study found.

But SNFs shouldn’t necessarily hit the panic button. The study, which was published in the Journal of the American Medical Association (JAMA), found that just 1.7% of the 295 patients in the hospital-at-home (HaH) program were admitted to a SNF, compared with 10.4% for the 212 control patients. But the study chose patients in part based on patient preferences, and that could affect the SNF finding, Matthew Press, an associate professor at the University of Pennsylvania Perelman School of Medicine, told Skilled Nursing News.

Press is the author of a commentary on Mount Sinai study of the the hospital-at-home care program that was also published in JAMA on June 25. He was optimistic about the timing of the results, particularly in light of advances in payment and technology, but stressed that the study had some methodological limitations.


“The way the study was set up, I think there was a potential for differences between the control group and the intervention,” he told Skilled Nursing News. “There’s a chance that patients who were in the intervention group, the HaH group, had either less acute conditions or more social and family support, and those are the reasons why their SNF utilization was lower, rather than something inherent to HaH itself.”

The Centers for Medicare and Medicaid Services had actually planned to do an independent evaluation of the study, but were unable to in part because of the self-selection issue, Press noted.

Payment is another concern. Even though the authors proposed to the Department of Health and Human Services (HHS) that there be a bundled payment mechanism for HaH, the study was funded by a grant, Press said.


But he stressed that the study comes at a critical moment for care in the home, adding that the findings present “a ripe opportunity” for the Center for Medicare & Medicaid Innovation (CMMI) and other players to come together to examine payment policy and do a large-scale test of the HaH concept.

“The whole idea with technological innovation and payment innovation is for care to be delivered in the setting that best meets the patient’s needs,” Press said. “Not necessarily in the setting that we’ve always delivered care, or that the payment systems dictate, but the setting that best meets patient needs. So ultimately skilled nursing providers — just like any other health care provider — should want that.”

Written by Maggie Flynn

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