Hospital at Home: Paying for What It's Worth COMMENT

On November 25, 2020, CMS announced the creation of an Acute Hospital Care at Home program to reimburse qualifying hospital-at-home models. As we increasingly adopt the Acute Hospital Care at Home program and similar home-based services, it is crucial to better define the value of these programs and their appropriate reimbursement rates. We provide a framework centered around cost, quality, and equity to help accomplish this task. Quality reporting should use both inpatient-specific and home health care-specific metrics, equity-focused process metrics and risk-adjusted outcome metrics, and validated diseasespecific tools. Costs should be measured comprehensively and uniformly through the use of time-driven activity-based costing and consider caregiver opportunity costs. It is also worthwhile to consider personal, societal, technical, and allocative value when determining the value and subsequent reimbursement rates of hospital-at-home programs. With careful patient selection, the hospital-at-home model has the potential to significantly benefit a subset of patients. To create sustainable reimbursement mechanisms for hospital-at-home programs, we first need a better definition of the value provided by this model of care.