{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T21:26:08Z","timestamp":1791926768045,"version":"4.3.4"},"reference-count":28,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2021,4,2]],"date-time":"2021-04-02T00:00:00Z","timestamp":1617321600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["agsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J American Geriatrics Society"],"published-print":{"date-parts":[[2021,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Hospital at Home (HaH) is a growing model of care with proven patient benefits. However, for the types of services required to provide an episode of HaH, full Medicare reimbursement is traditionally paid only if care is provided in inpatient facilities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>This project identifies HaH services that could be reimbursable under Medicare to inform episodic care within fee\u2010for\u2010service (FFS) Medicare.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>All data are derived from acute services provided from the Mount Sinai HaH program between 2014 and 2017 as part of a Center for Medicare and Medicaid Innovation (CMMI) demonstration program.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>\n                      The sample was limited to patients with one of the following five admitting diagnoses: urinary tract infection (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u200970), pneumonia (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u200960), cellulitis (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u200945), heart failure (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u200937), and chronic lung disease (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u200924) for a total of 236 acute episodes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements<\/jats:title>\n                    <jats:p>HaH services were inventoried from three sources: electronic medical records, Medicare billing and itemized vendor billing. For each admitting diagnosis, four reimbursement scenarios were evaluated: (1) FFS Medicare without a home health episode, (2) FFS Medicare with a home health episode, (3) two\u2010sided risk ACO with a home health episode, and (4) two\u2010sided risk ACO without a home health episode.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Across diagnoses, there were 1.5\u20131.9 MD visits and 1.5\u20132.7 nursing visits per episode. The Medicare FFS model without home health care had the lowest reimbursement potential ($964\u2013$1604) per episode. The Medicare fee\u2010for\u2010service within ACO models\n                      <jats:italic>with<\/jats:italic>\n                      home health care had the greatest potential for reimbursement $4519\u2013$4718. There was limited variation in costs by diagnosis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion and Relevance<\/jats:title>\n                    <jats:p>Though existing payment models might be used to pay for many HaH acute services, significant gaps in reimbursement remain. Extending the benefits of HaH to the Medicare beneficiaries that are likely to derive the greatest benefit will require new payment models for FFS Medicare.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgs.17140","type":"journal-article","created":{"date-parts":[[2021,4,2]],"date-time":"2021-04-02T08:08:38Z","timestamp":1617350918000},"page":"1982-1992","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Hospital at Home services: An inventory of\n                    <scp>fee\u2010for\u2010service<\/scp>\n                    payments to inform Medicare reimbursement"],"prefix":"10.1111","volume":"69","author":[{"given":"Linda V.","family":"DeCherrie","sequence":"first","affiliation":[{"name":"Department of Geriatrics and Palliative Medicine Icahn School of Medicine at Mount Sinai  New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liane","family":"Wardlow","sequence":"additional","affiliation":[{"name":"West Health Institute  La Jolla California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine A.","family":"Ornstein","sequence":"additional","affiliation":[{"name":"Department of Geriatrics and Palliative Medicine Icahn School of Medicine at Mount Sinai  New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Crowley","sequence":"additional","affiliation":[{"name":"West Health Institute  La Jolla California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Lubetsky","sequence":"additional","affiliation":[{"name":"Department of Geriatrics and Palliative Medicine Icahn School of Medicine at Mount Sinai  New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy R.","family":"Stuck","sequence":"additional","affiliation":[{"name":"West Health Institute  La Jolla California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Albert L.","family":"Siu","sequence":"additional","affiliation":[{"name":"Department of Geriatrics and Palliative Medicine Icahn School of Medicine at Mount Sinai  New York NY USA"},{"name":"Geriatric Research, Education, and Clinical Center James J Peters Veterans Affairs Medical Center  Bronx New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,4,2]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-143-11-200512060-00008"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2011.1132"},{"key":"e_1_2_13_4_1","article-title":"Early discharge hospital at home","volume":"1","author":"Shepperd S","year":"2009","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.5694\/mja12.10480"},{"key":"e_1_2_13_6_1","article-title":"Admission avoidance hospital at home","volume":"4","author":"Shepperd S","year":"2008","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.1999.tb01592.x"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.5694\/j.1326-5377.1999.tb127711.x"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2018.2562"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2008.02006.x"},{"key":"e_1_2_13_11_1","unstructured":"Conditions for Coverage (CfCs) & Conditions of Participation (CoPs) Centers for Medicare & Medicaid Services. 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