Buzz around hospital-at-home programs, which allow patients to receive acute-level care at home while shaving down costs, was snowballing even before the pandemic drove unprecedented use of virtual care and remote monitoring tools.
But widespread adoption of such models has been hamstrung by physician uncertainty and patchwork reimbursement policies. And a government waiver that threw open the doors to providing hospital care at home during the pandemic is set to expire when the public health emergency does, sparking concerns among hospital-at-home proponents that much of the progress made in the arena during COVID-19 could quickly roll back.
“Most healthcare organizations say moving care to the home is a strategic priority,” Chris McCann, CEO of care-at-home tech platform Current Health, told Healthcare Dive on the sidelines of the HIMSS annual conference on Wednesday. “Fewer have done that.”
Physician reluctance
Hospital at home has seen progress in some areas, including in investment and interest from major hospital systems like Kaiser Permanente and Mayo Clinic. But uptake is slow, as some patients and providers are reluctant to participate. Change management is a major roadblock to wider adoption, experts said at HIMSS.
Hospital staff are particularly concerned as to whether they can deliver the same quality of care in a patient’s home as in the hospital. That makes them unwilling to refer patients into hospital-at-home programs, even if doctors and nurses support the concept in principle. Additionally, some providers are worried about added legal risk stemming from malpractice accusations, in the event of an adverse clinical event in the home.
In one example, HCA Healthcare — one of the largest operators — was running an at-home care program for patients with COVID-19, but found few providers were willing to discharge them.
“Our providers didn’t feel comfortable sending them home,” HCA chief nursing informatics officer Sherri Hess said Monday. Hess noted it cost more to keep patients in the hospital, while their vitals could easily be monitored in the comfort of the home. “Was that really the right thing to do?”
It’s difficult for clinicians to adapt to treating patients at home, as opposed to in the hospital, according to Nathan Starr, lead telehospitalist for Intermountain Health.
That’s “one of the hardest things for clinicians” — that loss of control, Starr said Tuesday. “Frankly, we’ve had some physicians who have really struggled with that.”
There’s no quick fix to this problem. Hospital workers need to become comfortable with using telemedical resources, and trust the patient and their family to be honest about symptoms and adhere to the care plan, Starr said.
Unsubstantiated concerns about added expense
When telehealth blew onto the scene in force early 2020, some industry watchers were concerned virtual care would contribute to higher healthcare costs, by becoming an additional patient visit in lieu of a replacement for an in-office encounter. Those concerns have also dogged hospital-at-home programs, despite evidence that well-monitored treatment at home can be less expensive and just as or more effective than traditional hospital care.
The model can save 30% or more per admission, while delivering fewer complications than in-hospital care, according to one pilot.
“I’ve seen the arguments on how hospital at home could add cost. I don’t believe them and I don’t believe it because it’s not what we’re seeing in the data, and it’s not what we’re seeing in hospitals on the ground,” McCann said.
Current, which was recently acquired by Best Buy as part of the retailer’s growing focus on in-home care, has a presence in the United Kingdom, which is farther along than the U.S. in terms of hospital-at-home adoption. The company’s UK business has saved 6,500 bed days across 1,000 patients, with roughly 99% patient satisfaction, McCann said.
“Where we want to get to with hospital at home is we’re actually replacing the entire inpatient stay,” and running the entire episode of care at home, said Starr from Intermountain, which has been an early adopter of at-home care models. “Otherwise we’re really just adding medical expense.”
