Bill Overview
Title: Hospital Inpatient Services Modernization Act
Description: This bill extends the Acute Hospital Care at Home Program under Medicare until two years after the end of the COVID-19 public health emergency (the program allows hospitals to treat certain patients from emergency departments or inpatient hospital beds at home during the emergency period). It also requires an evaluation of this program and the Hospital Without Walls program (the program allowed hospitals to transfer patients to outside facilities, such as hotels, to continue treatment during the emergency period).
Sponsors: Sen. Carper, Thomas R. [D-DE]
Target Audience
Population: Individuals eligible for Medicare, primarily older adults and people with disabilities.
Estimated Size: 63000000
- The bill concerns the Acute Hospital Care at Home Program under Medicare, which targets people who are eligible for Medicare coverage.
- Medicare primarily covers individuals who are 65 years and older, as well as some younger individuals with disabilities or specific conditions.
- As of 2021, approximately 63 million people were enrolled in Medicare in the United States, which includes the elderly population and those with disabilities.
- Many other countries do not have a system comparable to Medicare, so the global population might primarily be affected by similar policies in other nations during a global public health emergency.
Reasoning
- The target population for the policy primarily consists of older adults over 65 years of age and people with disabilities who are eligible for Medicare.
- We've estimated that approximately 63 million people could potentially be eligible for this program in the United States, based on Medicare enrollment data.
- The policy is significant due to the massive potential impact on the healthcare system and individual patient outcomes, potentially alleviating hospital over-crowding by providing at-home care.
- Since the policy is constrained by budgetary limitations, not everyone eligible will receive the benefits, hence the impact can vary widely across different individuals.
- The interviews simulate a variety of Medicare-eligible individuals, including both beneficiaries directly impacted by the policy and those who may not feel its effects due to selection criteria or regional limitations.
Simulated Interviews
Retired nurse (New York, NY)
Age: 72 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 2.0 years
Commonness: 16/20
Statement of Opinion:
- I believe being treated at home will reduce my anxiety about hospital visits.
- Having a nurse visit once a day might be less daunting than staying in a hospital.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 6 |
| Year 2 | 9 | 6 |
| Year 3 | 7 | 5 |
| Year 5 | 6 | 5 |
| Year 10 | 5 | 4 |
| Year 20 | 4 | 3 |
Retired teacher (Miami, FL)
Age: 65 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 1.5 years
Commonness: 14/20
Statement of Opinion:
- It's hard to travel to hospitals often, home care sounds more convenient.
- Concerned about how quickly hospitals can send help if needed.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 5 | 5 |
| Year 5 | 5 | 5 |
| Year 10 | 4 | 4 |
| Year 20 | 3 | 3 |
Retired accountant (Dallas, TX)
Age: 78 | Gender: female
Wellbeing Before Policy: 4
Duration of Impact: 2.0 years
Commonness: 10/20
Statement of Opinion:
- Having treatments at home would ease some physical strain.
- I'm worried about the quality of home care compared to the hospital.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 4 |
| Year 2 | 7 | 4 |
| Year 3 | 6 | 4 |
| Year 5 | 5 | 3 |
| Year 10 | 4 | 3 |
| Year 20 | 3 | 2 |
Retired engineer (Seattle, WA)
Age: 70 | Gender: male
Wellbeing Before Policy: 3
Duration of Impact: 2.0 years
Commonness: 12/20
Statement of Opinion:
- Hospital stays are difficult, having more time at home would be great.
- Skeptical about the availability of these services in my region.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 3 |
| Year 2 | 7 | 3 |
| Year 3 | 5 | 4 |
| Year 5 | 5 | 3 |
| Year 10 | 5 | 3 |
| Year 20 | 4 | 2 |
Retired librarian (San Francisco, CA)
Age: 66 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 2.0 years
Commonness: 10/20
Statement of Opinion:
- Managing my own health and my spouse's health at home would be reassuring.
- Hope that this program reduces overall hospital wait times.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 7 | 5 |
| Year 3 | 6 | 5 |
| Year 5 | 6 | 5 |
| Year 10 | 5 | 4 |
| Year 20 | 4 | 3 |
Retired farmer (Rural Iowa)
Age: 85 | Gender: male
Wellbeing Before Policy: 4
Duration of Impact: 1.0 years
Commonness: 8/20
Statement of Opinion:
- Traveling to hospitals is a huge burden, home care could be life-changing.
- Worried about enough trained staff available in rural areas.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 4 |
| Year 2 | 6 | 3 |
| Year 3 | 5 | 3 |
| Year 5 | 5 | 3 |
| Year 10 | 4 | 3 |
| Year 20 | 4 | 2 |
Retired teacher (Chicago, IL)
Age: 68 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 2.0 years
Commonness: 14/20
Statement of Opinion:
- Having more medical support at home would be miraculous.
- Curious to see if my insurance will fully cover these services.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 6 | 5 |
| Year 5 | 6 | 5 |
| Year 10 | 5 | 4 |
| Year 20 | 5 | 4 |
Retired professor (Boulder, CO)
Age: 90 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 1.0 years
Commonness: 6/20
Statement of Opinion:
- My independence is important, and this might extend it.
- Wonder if assistance in care facilities will be as good as in hospitals.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 5 | 5 |
| Year 5 | 5 | 5 |
| Year 10 | 5 | 5 |
| Year 20 | 4 | 4 |
Retired postal worker (Atlanta, GA)
Age: 82 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 1.5 years
Commonness: 11/20
Statement of Opinion:
- I'm hopeful that this program makes long-term dialysis easier.
- Skeptical about how smoothly the program will be implemented.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 5 | 4 |
| Year 5 | 5 | 5 |
| Year 10 | 5 | 5 |
| Year 20 | 4 | 4 |
Retired artist (Los Angeles, CA)
Age: 69 | Gender: female
Wellbeing Before Policy: 4
Duration of Impact: 2.0 years
Commonness: 9/20
Statement of Opinion:
- Traveling can be difficult, so home-based care would be ideal.
- Concerned about the costs beyond Medicare coverage.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 4 |
| Year 2 | 6 | 4 |
| Year 3 | 6 | 4 |
| Year 5 | 5 | 4 |
| Year 10 | 5 | 4 |
| Year 20 | 4 | 3 |
Cost Estimates
Year 1: $500000000 (Low: $400000000, High: $600000000)
Year 2: $510000000 (Low: $405000000, High: $615000000)
Year 3: $520200000 (Low: $416100000, High: $624360000)
Year 5: $540408000 (Low: $432326400, High: $648489600)
Year 10: $587252480 (Low: $469801984, High: $704703360)
Year 100: $2444409600 (Low: $1955527680, High: $2923291520)
Key Considerations
- The continuation and transformation of emergency policies to more permanent strategies.
- Balancing short-term costs with long-term savings and healthcare system efficiencies.
- Potential impacts on healthcare service quality and patient satisfaction at home versus hospital care.
- The need for technological investments in telehealth and remote monitoring systems is inherent in enabling successful program execution.