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Hospital At Home: Better Outcomes, Lower Costs

Hospital at Home

Eight years ago, the Mount Sinai network of seven hospitals in New York City launched a Hospital at Home program that shifted care for certain patients from the hospital to home.

By Al Norman

Eight years ago, the Mount Sinai network of seven hospitals in New York City launched a Hospital at Home program that shifted care for certain patients from the hospital to home.

The program focused initially on Medicare patients with conditions like congestive heart failure, pneumonia and diabetes, but it expanded to include dozens of conditions, including asthma, high blood pressure and serious infections like cellulitis.

This shift of care from hospital to home has been popular for many years in such countries as Australia, England and Canada, but less common in the United States. But when hospital administrators and Medicare officials learned that Mount Sinai hospitals could reduce the average length of stay for these patients from 5.3 days in the hospital, to 3.1 days at home, and cut hospital 30-day readmission rates in half, the concept made financial bells go off.

One early trial of the Mount Sinai patients found that there were no adverse events in the home-care patients, and their treatment costs were significantly lower — about half that of patients treated in the hospital.

Another early-adopter of the Hospital at Home protocol was Brigham and Women’s Hospitals in Boston, part of the Partners Health Care system. Patients with heart failure, pneumonia, COPD, cellulitis or complicated urinary tract infections were “admitted to home” with monitoring support using “biosensor patches” that continually monitor vital signs, heart rate, respiratory rate, skin temperature, posture, step counts and falls. Patients had daily contact with clinicians to adjust care management plans when needed. A patient with any questions, could talk face-to-face via video chat anytime with a nurse or doctor at the hospital.

“The evolution of digital medicine makes us even more confident in the home hospital model for our patients,” a doctor managing the Brigham and Woman’s programs said.

premium, patient-centered, Social Security, ageist, nursing, COVID, Trump, vaccineIn a hospital setting, staff must be available 24/7, but patients at home often do not require round the clock skilled care. Home care patients had fewer lab tests and visits from specialists. In terms of satisfaction with care, patients were equally-satisfied with their care, and more physically active than patients in a hospital setting.

For those of us who have worked in the home care field, none of these findings are a surprise, but for hospital staff, the results may have been more unexpected. “Americans have been trained for 100 years to think that the hospital is the best place to be, the safest place,” said the Brigham and Women’s program medical director. “But we have strong evidence that the outcomes are actually better at home.” Elders can get disoriented or confused in a hospital setting, are less active physically, and are at risk of MRSA infections, suffer nutritionally, or becoming incontinent.

The Medicare program was slow to provide major funding for these hospital to home programs, but the Covid pandemic ironically encouraged the growth of programs that diverted people from hospital care. Covid overwhelmed hospitals (and nursing homes).  As one researcher wrote: “They needed a safe place for older adults, who were particularly at risk.”

By the fall of 2020, Medicare officials were allowing hospitals to apply for a waiver of the requirement provide round-the-clock on-site nursing care. Hospitals were paid the same for care as for in-hospital care. Hospitals in 37 states are now approved to provide Hospital at Home services under Medicare.

But Medicare waivers are not permanent. The Biden administration may extend the program early in 2023. “If this were made permanent, you’d see at least a thousand hospitals in the next few years” adopt Hospital-at-Home care, a geriatrician at Johns Hopkins University School of Medicine told the New York Times.

The future of Hospital-at-Home care may depend on Congressional action. A bill introduced in the House of Representatives (HR 7053) last March would extend the Medicare Waiver program for two years after the public-health emergency ends. The legislation did not advance, despite bipartisan support from 29 co-sponsors, but supporters believe that a similar bill could still pass.

Readers can reach their U.S. Senators or Representatives by calling 202-224-3121. As them to “pass HR 7053, the Hospital at Home program extension.”

Al Norman worked in the elderly home care field in Massachusetts for nearly 4 decades. He has been writing editorials for the 50+Life for nearly as long.

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