Hospital at Home Model for the Chronically Ill Expected to Get “Very Common”

Programs allowing chronically ill people with acute medical problems to get hospital services in their own homes have been found successful and cost effective, and may become “very common” in the future, writes Kaiser Health News

Patients who can’t be adequately cared for in a home setting are excluded from the hospital at home programs, and if their medical conditions become more dire or unstable, they’re transferred to a bricks-and-mortar hospital. 

To date, only a handful of “hospital at home” programs exist, and most focus on people with chronic obstructive pulmonary disease, congestive heart failure, pneumonia, and cellulitis, although some initiatives have expanded to care for patients with dehydration, urinary tract infections, and blood clots, among other medical conditions. 

The concept – which has been adopted in Australia, England, Israel and Canada — is getting attention here with increased pressure from the national health overhaul to improve the quality of medical care and lower costs. Hospital at home programs do both, according to research led by Dr. Bruce Leff, the director of geriatric health services research at Johns Hopkins School of Medicine in Baltimore who pioneered the concept.

In a study of three experimental hospital at home programs published in 2005 in the Annals of Internal Medicine, Leff demonstrated that patient outcomes were similar or better, satisfaction was higher and costs were 32 percent less than for traditional hospitalizations.

“It’s a very successful model and in five years, I think it’s going to be very common.  But we’re still in the early adoption phase,” said Mark McClelland, an assistant professor at the Center for Health Care Quality at George Washington University.

Resistance from Medicare and private insurers is the biggest problem these programs face.  Traditional fee-for-service Medicare does not pay for hospital at home services, although individual private Medicare Advantage plans may do so.  The Centers for Medicare and Medicaid Services “appears convinced it’s going to add to overall costs” and fearful that providers will admit patients inappropriately, said Erin Denholm, chief executive of Centura Health at Home, a division of Colorado’s Centura Health.

Several more healthcare systems in states including Illinois, Rhode Island, Florida, New York, Minnesota, and Colorado are in planning stages of launching hospital at home programs. Read more at Kaiser Health News

Written by Alyssa Gerace

Alyssa Gerace

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