Ensocare - Topics on readmissions, discharge process and improving patient care

What the 'Hospital at Home' Model Means for Care Planning

Written by Luis Castillo | 1/31/18 4:00 PM

It’s still the first month of the new year, so it’s not too late to make resolutions for what’s ahead in 2018. We thought it’d be appropriate to turn our attention this week to a new care model that has the potential to revolutionize medical care and that many hospitals are already resolving to look into a little more deeply.

I’m talking about the Hospital at Home® care model. 

Developed by doctors at Johns Hopkins, Hospital at Home® gives patients the opportunity to receive the type of care they would expect in a hospital from the comfort of their home. They have to meet certain criteria in order to be eligible, including suffering from a condition for which receiving care at home is possible. Here are a few:

  • Community-acquired pneumonia
  • Congestive heart failure
  • Chronic obstructive pulmonary disease
  • Cellulitis

The model has obvious benefits for patients (recuperating in a familiar environment with less disruption to their everyday lives) and providers (reducing costs associated with operations and hospital overhead fees). 

The fact that some of the most storied medical providers in the country are experimenting with completely new ways of providing care should cause everyone to stand up and take note. Many leading healthcare executives agree that the current state of healthcare will soon become untenable at current costs, what with rapidly inflating overhead, reduced Medicare payments and the ongoing shift to value versus volume.

This is a big deal. The Hospital at Home® model signifies a sea change in the way that we think about what it means to be a hospital as well as a hospital administrator.

Retro Healthcare

Here’s something important to consider: this shiny new care method that has everyone excited? Maybe we shouldn’t think of it as new. In fact, it’s arguably a return to the type of medical care we’ve engaged in for the vast majority of human history.

The idea of the hospital and the urgent care center as the centerpiece of the medical field is still a relatively new phenomenon in the grand scheme of things. 100 years ago, a majority of persons in cities and rural communities alike received their medical care from physicians who traveled into their homes.

But in the last century, the ranks of the traveling physician have dwindled to almost nothing. Instead, physicians developed independent practices where patients could come to them, and that idea itself has been supplanted by hospitals buying up said practices. This consolidates medical care and also increases hospital revenue.

It’s interesting to see some top hospital officials consider reversing course from the most recent standard. The concept of the traveling caregiver remains the same even if the physician and the care team who enter the patient’s home in the coming years take a very different form. They will be trained with modern medical knowledge, they’ll be more likely to enter your vitals into a tablet or Smartphone and they’ll be deployed by medical institutions who have the capability to gather and analyze data from patients across a vast geographic span. 

The in-home physician isn’t new. It’s just back. Call it the vinyl record of healthcare.

What This Means for Hospitals

Right now, this model mostly exists in the form of pilot projects. It’s yet to be widely deployed. But it’s not unreasonable to think that we might see it garner widespread acclaim and adoption, especially if the results continue to be as promising as they initially portend and we can figure out ways to apply this methodology to other maladies and care plans.

But is this something that your own facility ought to be looking into? If you’re inspired about taking your hospital on the road, you’ll need to consider a few things.

The first thing you’ll need to understand is the type of investment this requires, not just in money but in resources. If you’re serious about taking your provision of care outside the walls of your hospital, it will take a few early steps.

First, you’ll need to get your staff on board. What we’re finding is that nurses and physicians actually relish the chance to interact further with patients outside the confines of a hospital. Perhaps paradoxically, it actually simplifies care to what they probably went to medical or nursing school for in the first place: it’s them, the patient and the care they’ve been educated to provide. It removes all the administrative hurdles they’ve gotten used to dealing with over the years.

Technology is the next consideration as well as quite possibly your biggest challenge. Obviously, it’s a main differentiator between what an in-home care visit means now versus 100 years ago. Software has the ability to revolutionize what to expect from a visit into your patients’ homes.

You absolutely need a reliable means of communicating with patients. That requires an investment in Smartphones, apps, the works. You need the same access to patients as you would if they were checked in to a hospital where you can pay them a visit whenever necessary. That’s no easy feat, but the Hospital at Home® model proves it can be done.

When you imagine the array of machines and tubes a person in the hospital is hooked up to, this seems like a daunting task. But consider this: with the advent of wearable apps, there exists software that allows for the type of passive monitoring you rely upon in the hospital setting.

Patients and their families can be educated to gauge readings of those things that can’t be passively monitored: weight, glucose levels, blood pressure and more. This information can be entered into that same app on a daily, hourly or any other kind of basis deemed necessary by the physician.

The Savings

Right now, your thoughts are probably turning to cost. After all, you’re sending staff out into the field. That creates liability concerns and attendant increases in insurance rates, gas and maintenance costs, equipment acquisition fees and an extensive investment in technology.

Certainly, these add up, and I wish we could tell you there’s some huge, extra secret Medicare or Medicaid reimbursement code that automatically helps you balance the books. There’s not. Maybe someday, but not right now.

But traveling to your patients’ homes may create savings in some other areas. Hospital beds? Maybe you don’t need as many. Rather than constantly upgrading and expanding a facility every 10 to 20 years to keep up with patient demand, you can rely on the patients’ own home as an extension of your facility. This can lead to reduced costs that you can turn around and invest back into community health initiatives that tackle the social determinants of health.

Huge capital expenditures on buildings and their attendant overhead costs could soon become a thing of the past. That equates to big savings, and you can save further by using some of the revolutionary apps available and soon to hit the market to reduce your administrative costs. 

The Hospital at Home® model can act as an inspiration for the future of care planning. It signals a willingness in the provider community to rethink the current way of doing things, with a technology-centric approach to care that can have a positive impact on the patient population.

Is your hospital prepared to go back to the future?


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