When is a hospital not a hospital? When it is in your home.  On Feb. 23, Baptist Hospital issued a press release describing the Baptist Hospital at Home.

The press release states that advanced home care will be available for patients who are clinically stable but need more care than what can be provided as outpatients. Care that was traditionally offered inpatient can now be delivered at home thanks to advances in home monitoring. This home monitoring offers a 24/7 view of the patient’s vital signs and condition.

The program offers the following:

• A daily virtual visit with a physician.

• 24/7 virtual nursing oversight and communication. 

• At least two daily in-person visits by a community

   Paramedic. 

• Labs, imaging, IV therapy, and oxygen therapy.

• Pharmacy, nutrition, and care management services.

Any new program raises many questions for patients and families, and here are the FAQs.

FAQ:

Are hospitals allowed to provide hospital care at home?   During Covid the Centers for Medicare and Medicaid Services (CMS) started a program called “Hospital without walls”.  Medicare-participating hospitals must have 24/7 nursing services available, and this requirement was waived for this program.

Is this a permanent program? It is approved through 9/1/2030. 

Is my home really going to be turned into a hospital?  No, this is really an extension of home health care.

How do patients enter the Hospital at Home program?  Patients are accepted into the program when they present to the ER or are already hospitalized. Patients can begin their hospital care there and then continue it at home.

Who decides if I am a good candidate for the hospital-at-home program?  Either an ER doctor or a hospital physician.  The decision is based on your diagnosis, your stability, the care you will need, and whether you have a suitable home environment. 

Do I have to participate in the program, or can I opt for inpatient care?  This is a voluntary program, and you decide if it is right for you.

What are the most common diagnoses treated in this program?  Respiratory conditions such as pneumonia and chronic obstructive pulmonary disease (COPD).  Congestive Heart failure, Urinary tract infections, and cellulitis. 

Who isn’t a candidate for hospital-at-home care?  Any patient who is unstable may need the ICU or may need surgery.  You must also live near the hospital and have a safe, supportive home environment.

How does the quality of hospital-at-home care compare to inpatient care?  This is a new program, but initial studies show that the mortality rate is lower for patients treated at home versus those in the hospital.  Other quality measures were similar between the two groups, and the costs in the 30 days following the care were less in those treated at home.  

What is the key to success in the hospital-at-home program?  Careful selection of patients is important, as not all patients will be good candidates. 

What are the advantages of the program?  The patient’s vital signs are monitored 24/7, and two-way communication is also used.  If there are any issues, 24/7 virtual assistance is available, and care can be provided to prevent them.  Vitals are usually taken every 4 hours in the hospital, and through this program, you are monitored much more intensively.

What are the other advantages of the hospital-at-home program?  You avoid the risks of hospital-acquired infections, which can be fatal.  You are also in a familiar environment, which will lead to better sleep and reduce the risk of cognitive decline in the elderly.

Are there advantages for the hospital in this program?  Hospitals often have a shortage of beds, and patients wait in the ER for hours for one.  This program will free up hospital beds. 

Have we seen this before in medicine? Yes, in the past, all surgeries happened in hospitals, and many required long hospital stays. Now, many complex surgeries, like total joint replacements and advanced spine procedures, are performed as outpatient procedures. When these surgeries take place at a physician-owned ambulatory surgery center, they cost a lot less than at hospitals. 

Does the hospital offer any unique services for the hospital-at-home program, or can other entities manage this program? The key contribution for hospitals is being available for the 7% of patients who need to be transferred from home to the hospital.  The improvements in remote patient monitoring have made this program possible.  This is a great use of technology in healthcare.

Can my physician direct my care at home rather than in the hospital?  This would be the ideal situation, as it would provide continuity of care and the cost would be much lower than hospital-directed care.  Your physician could partner with home health agencies to provide the needed care.  Direct patient care (DPC) physicians would be ideally suited for this function. 

Hospitals are the most costly care sites, accounting for one-third of all healthcare expenses. We need to reduce hospital costs, and the best way to do this is by decreasing our dependence on them. The Hospital at Home program offers acute care at home, managed by physicians and NOT hospital care. This naturally extends home health care and should be reimbursed appropriately. However, CMS reimburses hospitals at the full inpatient rate.

The actuarial and consulting firm Milliman conducted a study comparing two payment methods for the Hospital at Home program. The first was the inpatient method currently in use, and the second was a home health-based payment model. Costs were $17,477 under the hospital-based pricing model and $10,413 under the home health-based pricing model.  An estimated 825,522 patients would be eligible for this program under Medicare.   There is potential for significant cost savings if acute care at home is physician-directed and reimbursed under a home health model rather than an inpatient model.

Baptist Health deserves praise for adopting this innovative model in our community. Careful patient selection, involving your personal physician and family, and following the treatment plan are key factors that increase your chances of success. 

However, ideally, this program will transition from hospital- directed to physician-directed.  In 1970, the first ambulatory surgery center opened in Phoenix, AZ. Surgeries that were inpatient a few years ago are now routinely performed on an outpatient basis. The U.S. healthcare system saves $38 billion annually due to ambulatory surgery centers. We need a similar shift away from inpatient care toward well-monitored, well-screened at-home care. This will leverage advances in health technology to restore patient-centered care. The new physician house call will replace traditional hospital stays. 

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