More and more patients and healthcare providers are hospital care But a permanent lack of federal funding could put such programs at risk.
The shift to home care began with the onset of the novel coronavirus in March 2020, when the Centers for Medicare and Medicaid Services (CMS) launched the Home Acute Hospital Care Waiver Program in response to a bed shortage.
This program allows hospitals to receive the same home health reimbursement as patients treated in a physical facility.
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Since the program's inception, hundreds of hospitals in 37 states have implemented it. home care For thousands of patients.
One is the Mass General Brigham (MGB) network in downtown Boston, which launched a home health program in 2016.
A growing number of patients and health care providers are touting the benefits of bringing hospital care into the home, but a permanent lack of federal funding could put these programs at risk. (General Brigham)
MGB Home Hospitals is one of the largest hospitals in the country, serving 66 regions from its five facilities.
Since its inception, the program has resulted in more than 2,400 home admissions and saved more than 12,700 acute care hospital days, according to a hospital press release.
Dr. Stephen Dorner, chief clinical innovation officer for MGB Healthcare at Home, spoke to Fox News Digital about the program's growth and goals and the benefits for patients and providers.
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“The January 2022 census was an average of nine patients, and now we are averaging 36 patients, with an overall capacity of 40 patients,” he said in a Zoom interview.
“We intend to continue to grow this number in the coming months and years until we ultimately move at least 10% of our current inpatient population out of hospitals and into patients' homes.”
Dorner believes home health care is a viable solution to the “massive capacity crisis” facing hospitals across the country.
One doctor said patients are “more willing to accept inpatient treatment at home because they are spending more time treating chronic conditions and want to spend more time at home.” Stated. (General Brigham)
“Health care costs too much,” he says. “Especially given the aging of the baby boomer generation and the amount of care they require. Extends lifespan — We have to find new and cheaper ways to do things. ”
The ability to provide acute inpatient care in the home is a “phenomenal” way to improve access to overall care and reduce health care costs, Dorner said.
Patient demands for home care
Although home hospital care is not suitable for everyone, many patients are happy to receive home care.
“The patients who are most willing to accept inpatient treatment at home are the ones who are the most understanding and aware of what their medical needs are,” Dorner told FOX News Digital.
“Healthcare costs too much…We have to find new ways to do things at lower cost.”
This typically includes patients with chronic illnesses that can lead to frequent hospitalizations. heart failure or chronic obstructive pulmonary disease, he noted.
“They are more willing to accept inpatient treatment at home because they are spending so much time treating their illness. chronic disease And they want to be able to spend more time at home,” the doctor said.
Dorner added that MGB has also had “great success” in admitting patients with new acute conditions it hasn't dealt with before, such as cellulitis, kidney infections and pneumonia.
Corporate office at General Brigham Hospital, Massachusetts. January 27, 2022 at Assembly Square in Somerville, Massachusetts. General Brigham Hospital in Massachusetts launched a home health program in 2016. (Getty Images)
“People can enjoy the creature comforts of being in their own bed, eating their own food, petting their recovering dog, having loved ones come visit them, and not having to travel to town and pay for it. We want parking and everything else,” he said.
Dorner also said patients enjoy the personalized nature of home care.
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“About 60% to 70% of our visits are actually done in the home as opposed to virtually,” he said. “So we send our doctors, nurses and physician assistants into patients' homes so they can see us directly. This gives us a unique perspective to understand the patient's home environment.”
He added: “Many patients say they never want to undergo hospital treatment again. They want to know how they can receive all their care from the comfort of their own home.” Ta.
“The patients who are most willing to accept inpatient care at home are the ones who are most understanding and aware of what their medical needs are,” says MGB Healthcare at Home Clinical Innovation. the chief executive told FOX News Digital. (General Brigham)
The program also has the potential to reduce provider burnout.
“We hear from our clinicians that the time they spend providing home health care is one of the most rewarding encounters of their careers,” Dorner said.
However, not all care can be brought into the home.
“We're not going to build an ICU in a home, we're not going to do a surgery in someone's living room,” Dorner said.
“But we want it to be able to complement our home base environment if the right conditions are right.”
“We're not going to build an ICU at home, and we're not going to do surgery in someone's living room.”
Dr. Shanna Johnson, Physical Therapy and Rehabilitation Physician in Scottsdale, Arizonaalso expressed support for the home hospital model.
“With appropriate patient selection, acute hospital care at home remains an important model of care to continue,” Johnson said. Mr. Johnson is not involved in MGB's programs or research.
The researchers found that patients who received home care had lower mortality rates (0.5% during hospitalization and 3.2% at 30 days). (General Brigham)
“For certain medical conditions, the quality and outcomes of care appear to be equal to or better than in-hospital treatment,” she added.
“Specifically, several studies have shown that it reduces complications of physical inactivity, such as pressure sores, reduces the need for skilled nursing facilities, and lowers readmission rates.”
Proven benefits
To measure the outcomes of hospital-at-home programs, MGB researchers recently conducted a study whose findings were published in the Annals of Internal Medicine.
The research team analyzed outcomes for 5,858 patients in the United States who received home health care from July 1, 2022 to June 30, 2023.
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Patients in the study had “medically complex conditions,” including 42.5% heart failure, 43.3% chronic obstructive pulmonary disease, 22.1% cancer, and 16.1% dementia, the researchers said. It pointed out.
The five most common discharge diagnoses were heart failure. respiratory infection (including COVID-19), sepsis, kidney/urinary tract infections, cellulitis, etc.
The researchers found that patients who received home care had lower mortality rates (0.5% during hospitalization and 3.2% at 30 days). Of these, only 62.2% were “escalated” to a hospital.
MGB researchers found that within 30 days of discharge, 2.6% of patients used skilled nursing facilities and 15.6% were readmitted. (St. Petersburg)
Within 30 days of discharge, 2.6% used a skilled nursing facility and 15.6% were readmitted to the hospital, which researchers said were lower than expected.
“Home hospitals serve patients with highly complex acute conditions, but these patients are not 'select' patients,” said study co-author and clinical director of research and development for home health at MGB. Dr. David Michael Levine told FOX News Digital.
“This is the first time we have been able to demonstrate the true complexity and acuity of patients cared for in this model on a national scale.”
Researchers also concluded that home hospitals provide “equitable care to traditionally underserved populations,” Levine said.
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“We know that in traditional hospital care there are large disparities in outcomes among underserved groups, but we don't see that in home hospitals.”
Johnson, who reviewed the MGB studies, said he found them consistent with the following: Previous research.
“This study of acute hospital care in the home showed lower rates of mortality, hospital escalation, and skilled nursing facility utilization,” she told Fox News Digital. “These positive results were seen in socially vulnerable patients as well.”
Health care providers are concerned that the Home Acute Hospital Care Program remains a temporary payment mechanism as the waiver expires in December 2024. (St. Petersburg)
However, the study was limited because it was based on observational data and there was no ability to compare the numbers with hospitalized patients.
“A lot of additional research is needed to compare home hospital patients to traditional hospital patients,” Levine says. “We treat home hospital patients, e.g. surgical patient Or labor and delivery patients. ”
He added: “If you simply look at all hospitalization numbers, yes those numbers are better, but that's not a worthwhile comparison. We're currently doing this more sophisticated analysis. That’s where I am,” he added.
Barriers to hospital care at home
Healthcare providers are concerned that home acute hospital care programs remain a temporary payment mechanism.
This exemption is scheduled to expire in December 2024 unless Congress takes action to extend or make it permanent.
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“Permanent payment mechanisms are essential to making home health care available to more people,” Levine told FOX News Digital.
“We want to do more to help policymakers and clinicians make informed decisions about waiver extensions and permanent approvals to expand opportunities for patients to receive care in the comfort of their own homes. We wanted to do this national analysis to get the data.”
The shift to home care began with the onset of the novel coronavirus in March 2020, when the Centers for Medicare and Medicaid Services launched the Home Acute Hospital Care Waiver Program in response to a bed shortage. (St. Petersburg)
When asked for comment, the American Hospital Association (AHA) issued a statement.
“Emerging evidence suggests that hospital care at home is safe, effective, and beneficial for many patients. We support the extension of regulatory flexibility and are working to ensure this innovative care model continues to have access to care for patients and communities. ”
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Fox News Digital reached out to the Centers for Medicare and Medicaid Services (CMS) for comment on a possible extension of the Home Acute Hospital Care Waiver Program.
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