I was intrigued by a recent Becker’s article which outlines the results of Mount Sinai’s use of the “Hospital at Home” model for acute care. According to the article, patient experience showed improvement and readmission rates were noticeably lower. I had to know more, so I decided to do some research into exactly what this model of care looks like.
It might sound like a blast from past, hearkening back to when house calls and traveling physicians were common, but the quality and scope of care is far from antiquated. Hospital at Home was pioneered in earnest at Johns Hopkins School of Medicine in 1995, and a series of pilot programs and research studies proved it to be feasible. Essentially, a patient is determined to have acute care needs that can be met under the program during admission to the hospital, and then that patient can consent to receiving care at home. At some points the patient may need to be briefly transported to an external facility for treatment that simply can’t be done in a home setting, but otherwise treatment takes place in the home.
People like convenience...
It’s no wonder why a patient would enjoy this experience more. Family and friends are able to visit at any time. The transition to aftercare is easier. Stress levels are absolutely lowered.
Hospital at Home stands in parallel to a few other ways we see the location of healthcare shifting. One of the most notable is the growth of telehealth. Ten years ago, the concept of seeing a doctor via Skype on your cell phone would have sounded unappealing or even ridiculous. Today, it’s a reality that many people are embracing.
I have friends who have actually used these telehealth services. They have gotten a quick diagnosis from their bedroom and have even been able to refill a prescription while in their pajamas. Their health ended up being a small part of their routine and not an afternoon-long ordeal. It only makes sense that patients should desire digital doctor visits, modern-day home visits, and even acute care in their homes.
But convenient doesn’t mean easy.
If these programs improve patient experience and have the same or better clinical results, why would we not be pushing to make them more widespread? As the Becker’s article succinctly mentions, payment models are a big blocker. We may be able to provide high-quality care to a patient in their home that they love, but we aren’t quite sure how we should bill them. Insurance companies aren’t sure how they should cover such care, either.
Although I am not a clinician, my own work in Value-Based Care has thoroughly demonstrated the difficulty of managing the revenue cycle for these more progressive care models. At a very basic level, our coding systems don’t always encompass these avenues of care. I’ve had many conversations with telehealth professionals and clinicians who lament that their unique way of billing makes getting their deserved compensation and staying compliant with regulatory programs burdensome.
Though these innovative models for care are providing powerful results and improving care, it may be awhile before we see them as a primary method of treatment for specific conditions or demographics. Even if the full realization is years away, though, it’s heartening to know that the experience of care is being honed and that, should my health ever require it, I may be able to get treated and recover at home.