April 28, 2021

There is a movie comedy set in rural Louisiana where a woman goes into the hospital, and her son—wanting to make her as comfortable as possible—fills her oversized suite with the rustic reminders of home, including the family’s live-in mule. Though silly and over the top, the scene does point to the fact that patients have a hankering for home, would rather be at home, and may even have a better shot at defeating disease from home. It’s no wonder, then, that there is a growing number of thinkers in both the health industry and the halls of government who are looking at an alternative way of delivering care for certain patients.

General Description

Leaders in healthcare solutions, like Johns Hopkins, have touted the potential upside of the so-called “hospital at home” (HAH) movement for more than a decade. The concept includes the use of remote monitoring and telehealth technologies to provide patients with hospital-level care, but without certain risks and costs associated with hospital stays. Clearly, some patient conditions call for inpatient care, but innovators of this concept have identified certain classes of patients who would make excellent candidates for at-home care. Early studies of this model indicate better recovery rates in some instances.

The HAH model today is seen as beneficial for older patients and those with chronic diseases, such as asthma, congestive heart failure and COPD. It has the added benefit of alleviating space in hospitals that have otherwise reached capacity. As the American population continues to age, this model of care will be seen as an increasingly appealing option for both facilities and patients.

Government Go-ahead

On November 25, 2020, the Centers for Medicare & Medicaid Services (CMS) gave hospitals facing a surge in COVID patients expanded flexibility to care for Medicare patients outside their campus with the creation of the Acute Hospital Care at Home (AHCH) program. This effort was meant as an extension of the Hospital Without Walls program that had been previously authorized by the federal government.

According to CMS, the AHCH program requires an in-person physician evaluation along with screening protocols to assess medical and non-medical factors before care at home begins. Candidates for such care can only be admitted into the program from emergency departments and inpatient hospital beds. After entering the program, a registered nurse must evaluate these patients on a daily basis in person or remotely, and either registered nurses or paramedics must conduct two in-person visits daily in accordance with the patient’s nursing plan and hospital policies. Hospitals are required to report quality and safety data to CMS at a frequency based on their prior experience with the HAH model.

Gauging the Progress

According to an interview with Daniel Durand, MD., chief innovation officer at LifeBridge Health in Baltimore, for Becker’s Health IT:

Virtually everyone is excited about the dawning of the age of the hospital at home. Physicians and patients see the opportunity for improved experience and outcomes by keeping patients who don’t need the hospital out of those buildings, which are essential for many types of care but also carry risks and costs that are best avoided by those who don’t need to be there. Payers and the government see tremendous value gains through the avoidance of the fixed costs of hospital-based care, much of which are driven by regulation and are thus unlikely to change regardless of the tech innovation landscape. Entrepreneurs and start-ups see that there is ample funding and a huge runway for growth as the population ages over the next three decades.
Dr. Durand went on to stress that innovations in remote monitoring and point-of-care diagnostics are rapidly expanding and that advancements in sensor technology, miniaturization and machine learning will allow for real-time remote monitoring of physiological parameters that traditionally can only be measured with costly hospital-based labs and equipment. For example, pocket ultrasound devices, portable MRI machines, non-invasive blood chemistry assessment and even smart toilet seats will be used increasingly in the future to help monitor congestive heart failure patients in their homes.

This all sounds wonderful and quite promising, but how does a hospital go about creating such a program as an adjunct to what they’re doing at their main campus?

Getting off the Ground

We’ve established the benefits of the HAH concept, and we’ve indicated that this model is likely to be increasingly pursued in the days ahead. The question is: is your facility ready to implement such a program? That is, is there a sufficient patient population base that would benefit from HAH and would HAH be financially tenable? If so, what are the next steps? Here are some items to consider:

You will need to identify and invest in supplies and equipment for HAH. There are websites that provide examples of the kinds of items being used in current HAH programs.
Your IT managers will need to determine the best way to network systems such as remote monitoring and other digital technologies so that data can be shared with clinical staff at the hospital and retained in the patient’s chart.
You will need to identify nurses and paramedics who would be able to make in-home visits, as well as nurses who would be responsible for the required initial evaluation. Work schedules and transportation issues would need to be considered.
You will need to set up protocols for circumstances that would trigger consideration of, and transfer to, HAH for a patient currently in the inpatient or emergency setting.
You will need to provide training to applicable staff.
Someone will need to design the overall at-home portion of the program, to include its goals, parameters, schedule, and termination.
Those in charge of the program should implement a way to closely assess the progress, successes and shortcomings of the hospital’s overall program. These findings should be used to improve outcomes and efficiencies.
For those interested in pursuing a HAH program through their facility, you should begin by applying for participation in CMS’s AHCH initiative via an online portal. The portal and additional resources can be found at: Acute Hospital Care at Home (cms.gov). During the program application process, prospective participants are required to explain how they’re able to meet their patients’ pharmacy, respiratory and other needs in the home setting.

MiraMed Global Services is glad to provide this kind of information to the hospital community. We also offer business solutions to health facilities across the nation. For a full list of our services, please visit www.miramedgs.com or email us at info@miramedgs.com.