Hospital-at-Home: Has Its Time Arrived?

As the Hospital-at-Home care model is gaining traction, does your agency have an opportunity to play a role and expand your patient base?

In this blog post and embedded podcast, you’ll hear from a leader at a major health system that is already delivering COVID Care-at-Home and examining a full-blown Hospital-at-Home model that allows patients formerly earmarked as hospital-bound to instead receive care where they live. Cooper Linton – associate VP of Duke HomeCare & Hospice (part of the Duke University Healthcare System) – shares some intriguing experience and insights on these matters.

 

A shift in healthcare strategy

On the surface, this approach seems counter-intuitive to how hospitals have typically operated for decades. Keeping “heads in beds” was the shorthand phrase that dominated hospitals’ strategy for success. But the landscape started to shift quite a few years ago.

Insurance companies began pushing for hospital discharges as early as possible. Then CMS started penalizing hospitals financially for readmissions of the same patients with the same conditions within 30 days.

Thus, hospital strategies may not have fully shifted from “heads in beds,” but the circumstances prompted a change of higher patient turnover … “different heads in beds,” if you will.

Now, the combination of a growing senior care glut and the lingering COVID-19 pandemic has sparked a significant new wrinkle – keeping more patients out of the hospital, period, and receiving care at home where they prefer to be.

“We can’t continue down this path where we just build bigger boxes to hold more and more patients,” Cooper said. “We’re going to have to look at how do we deliver care differently in a value-based purchasing world or around risk-sharing world, and there’s also a recognition that we’ve got to find ways to lower the cost of care.”

Hospital-at-Home programs take root

During the past 10 years, a few pioneering health systems, including Mt. Sinai and Johns Hopkins, have been testing Hospital-at-Home models. According to an article in Home Health Care News, these models have achieved shorter average lengths of stay compared to traditional in-patient care, at 3.2 days compared to 5.5 days, respectively. Additionally, Hospital-at-Home models have substantially lowered rates of hospital readmissions and reduced rates of emergency department visits.

Like other aspects of healthcare, the COVID-19 pandemic accelerated the interest in Hospital-at-Home options. In March 2020, CMS announced the Hospitals Without Walls program, which provides broad regulatory flexibility allowing hospitals to provide services beyond their own facilities. According to the CMS.org website, CMS is expanding on this effort by executing an innovative Acute Hospital-At-Home program, providing eligible hospitals with unprecedented regulatory flexibilities to treat eligible patients where they live.

CMS believes that treatment for more than 60 different acute conditions, such as asthma, congestive heart failure, pneumonia and COPD care can be addressed with in-home care without compromising patient safety and outcomes.

The intersection of COVID Care-at-Home and Hospital-at-Home is where Cooper Linton can offer valuable insights based on his growing experience with these services.

Key considerations for Hospital-at-Home

• Prepare for different equipment needs. Higher acuity patients likely will need different equipment and supplies than historically typical home care patients. With COVID Care-at-Home patients, for example, Cooper said there was a greater demand for oxygen and concentrators.“They needed to be on a manageable O₂ volume,” Cooper explained. “Many times, we talk about a patient being on two liters of oxygen per minute or four liters of oxygen per minute. We were managing 8, 10 and 12 liters of oxygen per minute at home. But there’s some real limitations around oxygen availability and the ability to manage concentrators in the home. So, we wanted to keep (home care eligible) patients closer to that 8 to 10 range even with exertion. We had to have conversations with some (DME) organizations and say, ‘No harm, no foul, but are you able to do this? And are you willing to do this? And in what level of turnaround and service response can we expect?’”
• Prepare for different staffing models. It also makes sense that higher acuity patients will require more clinical time for care. “Our costs for managing these patients in the home are much higher,” Cooper said, “because instead of doing a home health patient where you make, say, three visits in a week or four visits in a week, we’re doing two visits in a day or one regular visit plus a virtual visit, plus a provider virtual visit or a joint nurse and provider visit, where one of them is virtual.”These logistics obviously will impact an agency’s staffing and scheduling models. And it also entails the next point…
• Prepare to fully integrate remote patient monitoring and other telehealth technologies. “We are going to have to find ways to look at technology as a way to extend care into homes in a way that we’ve never done it before,” Cooper said. “We’ve got to be able to harness the power of a cell phone or a similar device with the diagnostic peripherals in the home and do that in a way that’s cost-effective to free up the very limited and valuable time of our clinicians. We’re going to have to be able to partner with that level of technology to do remote patient monitoring, concurrent televisits and in-person visits. I just think it’s something all of us are going to have to get focused on diligently for the next few years.
• Prepare for high patient satisfaction and other good outcomes. National surveys by Transcend Strategy Group and others have made it clear that family caregivers prefer to keep their loved ones at home – and patients would rather stay at home, too. Hospital-at-Home allows that to happen, without sacrificing the quality of care and strong outcomes.

“The outcomes have been good,” Cooper commented. “We’re not seeing any higher rate of readmission on these patients than we would see in a typical home health facility-based readmission rate. In fact, we’re doing better than a lot of the Medicare data that we’re seeing for our market. Where we’ve really seen things shine is the patient satisfaction. Patients are just glowing about this.”

Can independent agencies partner with health systems to deliver Hospital-at-Home?

So you may be thinking, “It’s all well and good for hospitals to look at this model, especially with the changes in CMS regulations. But my agency isn’t a hospital. How does Hospital-at-Home affect my organization?”

Consider this: Duke University Healthcare System is an exceptional example of a hospital that already has a home care service line in place. Most hospitals don’t. Most hospital systems aren’t set up or experienced in providing care beyond the walls of their facilities.

That’s where your agency may come in. You’re deeply experienced in providing quality care at home. Is there an opportunity for you to partner with a major hospital provider in your area to provide care for their patients at home when appropriate? It’s something to think about and possibly pursue.