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One of the less celebrated health-care successes in the pandemic was that 148 hospitals in 32 states used Medicare waivers to provide acute medical care to seniors in their own home.
It not only kept seniors safe from Covid-19, but hospital care was delivered to them with a high level of quality, at lower costs and with high patient satisfaction scores.
For seniors especially, this is a model that has worked well, and with the emergence of the more contagious delta variant, we see the ongoing benefits of keeping seniors out of the hospital. The next step is to take what we learned and refine the process, and improve Medicare practices even beyond the pandemic.
Imagine a future where a senior goes to a primary doctor with suspected pneumonia and is not then sent to the emergency room to be admitted to the hospital, but rather could go home and have hospital-level care come to her house.
Now, imagine that senior is you, some years in the future. Or your mom, now.
Hospital-grade care at home
This so-called hospital-at-home model had become more prevalent even prior to Covid-19, but systems like Medicare are still integrating the best practices. But all of the pieces are already in place to advance how we deliver hospital-grade health care at home: Even the most sophisticated hospital-grade medical equipment is becoming smaller and portable — small enough to allow hospitals to come to your bedside. In the pandemic, telehealth and remote monitoring also became more widely available, breaking down another barrier to home care.
In 2020, two policies offered flexibility to hospitals that sought to provide services off-site from their own locations. The Centers for Medicare and Medicaid Services (CMS) introduced a Hospitals Without Walls initiative in March 2020; in November last year, CMS announced the Acute Hospital Care at Home program covering hospital-level care at home for Medicare fee-for-service (FFS) beneficiaries at approved sites. Prospective health systems could access the program, subject to approval by CMS based on their ability to meet certain requirements.
The model proved itself in the pandemic — 69 health systems signed on — and the industry belief is that CMS is looking at making the program permanent even as the world reopens. Policies can be refined to drive further value for Medicare beneficiaries while we look to how this model could be used in the future.
Referrals from the right settings
One critical factor is that patients should be referred for home care from the right settings. Right now, for a patient to be admitted via a Medicare waiver for hospital care at home, they first need to go — unbelievable, but true — to a hospital.
I work in health-care logistics, but it doesn’t require much in the way of expertise to see the problem. Going to the emergency room to gain access to hospital services at home is like driving to the movie theater, paying admission and buying a $12 bucket of popcorn — just to bring it home with you to watch Netflix.
Remember: This is not the house call of bygone days. There is no doctor with a black medical bag and a stethoscope, petting the dog. Modern hospital-at-home efforts provide a continuum of care: a team of specialists — for instance, technicians, nurse practitioners/physician assistants, bedside nursing and internal medicine physicians — bringing everything from advanced imaging equipment to IVs or oxygen. In short, much of what you’d get at a hospital, aside from surgery or the ICU.
In a $4 trillion health-care market, we need ways to get reduce costs. In-home hospitalizations save $5,000-$7,000 per episode. On average, total costs have been shown to be between 19% and 30% lower than in traditional inpatient care.
Early studies by Johns Hopkins Medicine show that hospital-at-home patients experience better clinical outcomes, including lower mortality rates, lower use of sedative medication and lower use of restraints. Patients and family members are left more satisfied, and less stress is put on the caregiver.
The home is a data-rich environment
In fact, better support can be provided in the home because providers can see more of what might be making it difficult for a patient to get well. One example: A chronic obstructive pulmonary disease patient was having trouble paying her electric bill. When her electricity was shut off, she was not able to use her oxygen, her condition worsened and she would go to the hospital repeatedly. When medical teams were able to admit her into her home, they could identify the problem and contact her Medicare Advantage plan to help pay for electricity, rather than pay for her to be admitted to the hospital over and over.
Even as we try to improve healthcare costs in the U.S., it’s like trying to redesign a car still built on the chassis of the old “fee-for-service” model, where providers get paid for doing things the same old way, without being held to driving outcomes and reducing costs. If we truly want to move to value-based care, we need to be more creative with payment models to drive further care in the home to build a more sustainable “car” moving forward.
The costs of health care demand that we rethink everything that we think we know about how care is “supposed to” be delivered. And reimagining aging in America as something we more often do from the comfort of our own homes rather than in a facility? That seems like a pretty nice bonus.
Kevin Riddleberger is the co-founder and chief strategy officer of DispatchHealth.
