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By: Jennifer A Tussey, PharmD, AAHIVP

Hospital-at-home (HaH) was originally developed more than 25 years ago by Johns Hopkins Schools of Medicine and Public Health, but recently, it has gained widespread attention through the COVID-19 pandemic. In November 2020, Centers for Medicare and Medicaid Services (CMS) expanded a previous program to include the Acute Hospital Care at Home program. CMS is now accepting waiver requests to the rule that requires 24/7 nurse support, in order to allow acute hospital services within the home of a patient. This waiver must be requested for each individual hospital, and cannot be completed for a hospital system. Hospitals who have already treated 25 patients via the HaH program will have an abridged process, in order to quickly expand access to those with experience. This program not only allows patients to be treated in the comfort of their own home, but it frees up space in the hospital for more complicated diagnoses.

One consideration for pharmacy participation is how to dispense medications through the HaH program. Outpatient retail pharmacies may be better suited for delivery of medications outside the hospital, but their hours and availability of a clean room may be a limitation. Inpatient pharmacies and their drug availability have their benefits, but they generally are not set up to send medication outside the hospital walls. Collaboration with a home-health agency or home infusion pharmacy may assist in the drug dispensing aspect of HaH.

Medication administration of IV medications and subcutaneous injections were typically completed by a nurse during their visit, but a pill-box, pre-filled by a nurse, could be utilized for oral medications in order to improve care while a patient is at home.

MSHP would love to hear your questions, concerns or comments regarding this change and how MSHP can help you at Jennifer.tussey@bjc.org.

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