Imagine receiving hospital inpatient services at home, or in a hotel room. That could soon be the reality in Florida.
The Senate Health Policy Committee on Wednesday approved legislation (SB 1222) that amends existing state health care laws to allow hospitals, physicians and emergency medical transportation providers to partner together to provide nonemergency services to patients.
Mayo Clinic Jacksonville Hospital has been offering inpatient services to its patients for more than a year under a pair of waivers granted by both the federal and state governments.
In November 2020, the Centers for Medicare and Medicaid Services approved a waiver that allows Mayo Clinic Hospital Jacksonville to offer inpatient services outside of the hospital and continue to receive Medicare and Medicaid reimbursement. It received a waiver from state hospital regulation rules from the state Agency for Health Care Administration in February 2021.
But the waivers will expire, and Sen. Aaron Bean said his bill establishes the necessary framework for Mayo Clinic Hospital Jacksonville and other Florida facilities interested in providing inpatient care outside of a hospital setting.
Before passing the bill, the Senate Health Policy Committee agreed to tag on an amendment that reworded the proposal to prevent what Bean called a “scope creep.”
Specifically, the bill authorizes certified paramedics working under the supervision of a physician to perform basic life support services, advanced life support services, and additional health care services to acute care at-home patients in nonemergency community settings. The bill also allows class III pharmacies — or those affiliated with a hospital — to dispense and distribute a compound and fill prescriptions for medicinal drugs for inpatients and acute care at-home patients in community settings.
The lion’s share of the patients — about 95% — are Medicare enrollees. However, the hospital also has agreements with eight commercial insurers that have agreed to reimburse the facility for inpatient services provided in an outpatient setting.
Mayo Clinic Hospital Jacksonville Medical Director Michael Maniaci told Florida Politics the facility has treated 1,500 patients, about 800 of whom were provided hospital inpatient care in the nearby Marriott Hotel, where some of the rooms have virtual technology so the patients can be watched. The “Care Hotel” program, as Maniaci calls it, provides post-procedure watching of patients in a virtual environment.
“These are patients that have a procedure that are deemed safe to go home. But at Mayo we are very cautious; our doctors like to watch people,” Maniaci said. “A lot of our patients are international or not local. So how do you keep an eye on them? You hold them in the hospital, especially if they don’t need hospital-level care. They just need somebody to keep an eye on them.”
Mayo also provides inpatient care outside its hospital walls at patients’ homes.
Bean likened it to the “Geek Squad” coming to a person’s home and outfitting it with hospital equipment.
Maniaci said ideal patients for the home program are medically stable but require lab work and treatment. They could be patients who have chronic medical conditions such as heart failure.
Patients can receive care for up to 30 days under the home care program, he said.
“We decided to own these patients longer. You don’t just get sent home after we are done. We actually watch you afterward. We educate you on your new medication and we make sure you follow up with your doctor. And if you have a problem, we escalate up care again so you don’t have to come back to the ED (emergency department) or have another emergency,” he said.
The results have been impressive, Maniaci said, with a 65% reduction in hospital readmissions.
While Mayo Clinic Hospital Jacksonville has been offering the services for about a year, it’s not the only Florida hospital with federal approval from CMS to do so. Tampa General Hospital recently received approval from the federal government to do the same.