Another excellent example of how Mobile Integrated Healthcare/Community Paramedic (MIH/CP) programs can partner with hospitals for a H@H program.
 
H@H programs can be an effective alternative to typical inpatient admissions, not only in rural areas, but also for other hospitals struggling with ED boarding due to limited inpatient resources at ‘brick and mortar’ facilities. Excessive ED boarding leads to delays in assessing ED patients which could negatively impact 2 key CMS hospital “Timely and Effective Care” quality metrics:

• ‘Percentage of patients who left the emergency department before being seen’
• ‘Average (median) time patients spent in the emergency department before leaving from the visit’

Source: https://data.cms.gov/provider-data/topics/hospitals/timely-effective-care#emergency-department-care
 
ED delays also impact hospital patient experience scores and may be a contributing factor to lengthy Ambulance Patient Offloading Times (APOT).
 
CMS specifically allows MIH paramedics to be part of the H@H team through an ongoing H@H waiver for this care model. There are several requirements that a hospital must meet in order to participate in the program. These include:

• Having appropriate screening protocols in place before care at home begins to assess both medical and non-medical factors
• Having a physician or advanced practice provider evaluate each patient daily either in-person or remotely
• Having a registered nurse evaluate each patient once daily either in-person or remotely
• Having two in-person visits daily by either registered nurses or mobile integrated health paramedics based on the patient’s nursing plan and hospital policies

Source: https://files.asprtracie.hhs.gov/documents/aspr-tracie-acute-care-delivery-at-home-tip-sheet-.pdf

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Sanford Fargo (ND) offers Hospital at Home
Feb. 24, 2025
 
https://news.sanfordhealth.org/news-release/sanford-fargo-offers-hospital-at-home/
 
FARGO, N.D. – Sanford Health Fargo is the first hospital in North Dakota to participate in the Hospital at Home program.
 
Hospital at Home gives patients the ability to transfer from the hospital to their home while continuing to receive care. Patients who are admitted to the emergency room or an inpatient unit and qualify for Hospital at Home can receive IVs, antibiotics, medications, treatments and ongoing care and observation from home until they are eligible for discharge.
 
The program includes two in-person caregiver visits a day from a nurse or community paramedic, as well as dailyvirtual visitswith a provider using a TytoCare device. Transportation is provided if patients need diagnostic tests at the hospital.
 
“Hospital at Home has a chance to be a real game changer for our patients. We are dedicated to ensuring high-quality care is accessible to all patients, regardless of their location or health challenges,” said Susan Jarvis, Sanford Fargo chief operating officer. “Hospital at home provides many benefits, such as more comfort, better sleep and greater independence with clothing, food and environment. This program also leads to less hospital-acquired infections, shorter hospitalizations and lower readmission rates. Sanford Health is committed to addressing rural health care challenges and providing high-quality, affordable care to everyone in our communities.”
 
The admitting provider and care team will assess each patient for eligibility in the Hospital at Home program. To qualify, patients must:
• Live within 25 miles of Sanford Medical Center Fargo
• Be at least 18-years-old
• Complete initial assessments at the medical center
• Have a diagnosis and care plan that can be safely provided at home
• Be comfortable using a TytoCare device
• Be able to move safely within their home
• Be able to follow home care instructions
 
It is recommended that patients have a caregiver in the home when joining the program.
 
About Sanford Health
Sanford Health, the largest rural health system in the United States, is dedicated to transforming the health care experience and providing access to world-class health care in America’s heartland. Headquartered in Sioux Falls, South Dakota, the organization serves 2.4 million patients and more than 425,000 health plan members across the upper Midwest including South Dakota, North Dakota, Minnesota, Wyoming, Iowa, Wisconsin and the Upper Peninsula of Michigan. The integrated nonprofit health system includes 56 hospitals, more than 270 clinic locations, 144 senior care communities, 4,500 physicians and advanced practice providers, nearly 1,000 active clinical trials and studies, and nine world clinic locations around the globe.