–by Eric Rock and Robin Hill
One of the “alternative care” concepts that has been receiving a lot of notice lately is Hospital at Home®. In this model, patients who would normally be admitted to the hospital from the emergency department (ED) or who would have an extended stay as an inpatient are instead sent home, where they will receive the same level of acute care they would normally experience in a hospital.
Typical candidates for Hospital at Home are patients who would ordinarily be admitted for 23-hour observation, or those already in programs to manage their chronic conditions who have an acute event. Patients with pneumonia, CHF, COPD, UTIs, pediatric cancer or those requiring wound care are often eligible. Any patient recommended for Hospital at Home, however, must first be cleared for it by a physician.
While this program may be new to some, it actually traces its origins to the mid-1990s. Dr. John Burton of the Johns Hopkins School of Medicine, and Dr. Donna Regenstreif of The John A. Hartford Foundation developed Hospital at Home as a means to safely bring down the cost of acute care while improving outcomes and patient satisfaction.
It offered a great deal of promise in that regard, but the healthcare industry wasn’t incented to pursue it. After all, there is little incentive to push patients out of the hospital under fee-for-service, although as value-based reimbursement arrangements emerge Hospital at Home becomes more attractive.
Then came 2020 and the COVID-19 pandemic. As hospitals reached (and exceeded) capacity, they needed to re-think who absolutely must be in the hospital and who can potentially move out to make way for new, sicker patients.
They also needed to minimize the risk of exposure to COVID-19 among their most vulnerable populations. Admitting them or keeping them in the hospital was clearly not the safest option.
So, Hospital at Home suddenly became a lot more interesting to hospitals, especially in areas undergoing pandemic surges. Here’s the challenge, though.
Delivering hospital-level care in any setting has traditionally involved equipping the room with a lot of large, complex and expensive equipment. That works in an actual hospital, where much of the equipment can be permanently stationed in patient rooms where they are used regularly.
But it takes a tremendous amount of time, work, and cost to move equipment into a patient’s home, set it up, calibrate it, connect it to the patient and the hospital, then reverse the entire process when the acute event has passed. Especially if all it was being used for was observation.
Fortunately, that was Hospital at Home in the old world. In today’s world, similar equipment and processes that are being used in remote patient monitoring (RPM) applications to help manage a patient’s chronic conditions can now also largely be used for Hospital at Home applications.
Pre-packaged kits of clinical-grade devices such as digital thermometers, EKG monitors, pulse oximeters, blood pressure monitors, etc. can be connected through a tablet or smartphone to deliver data to healthcare professionals on a recurring basis. Vivify Health, for example, has already been successfully enabling six health systems with their own “Hospital at Home” programs, and more are expected to follow this trend.
The cost savings alone make it worth investigating. Consider that a typical admission for 23-hour observation after heart failure will cost $12,000. RPM-powered Hospital at Home costs a fraction of that amount. With the added benefit that the patient will be at home, which will likely help speed recovery time while freeing hospital beds for patients with more serious or difficult conditions (such as COVID-19).
As vendor companies recognize the market potential, many will likely be eager to jump in and cash in on the sudden interest. New vendors create a risk of missteps that could cause the entire Hospital at Home program to be labeled ineffectual – when really it’s the execution that is the issue.
If your hospital is considering entering the Hospital at Home waters, look for a partner that already has the people, processes, technology and experience to deliver care that can connect. Vivify fits that bill.
We have been delivering RPM solutions for more than a decade and have refined not only the technology but all the processes surrounding it (including the logistics of deployment) to a science. Most important, however, is that we have a team that understands the environment and how to work with clinicians, as well as patients and their families, to drive proper usage and better outcomes. Our clinical analyst and consulting teams are made up primarily of former hospital nurses who understand the environment and challenges and are prepared to help frontline healthcare workers solve whatever issues they face.
As with anything new you’ll want guidance to ensure the right patients are being selected, the data is being monitored properly, and the right actions are being taken at the right time for the right patients. Vivify can help you with all of that. And, since we are experts in long-term RPM, we can even help you step patients with chronic conditions down to lower cost solutions to deliver the right level of monitoring, for as long as they need it.
If you are considering implementing a Hospital at Home program, be sure to speak with the experts at Vivify. Hospital at Home is a tremendous innovation that can solve many of healthcare’s greatest challenges. But it’s only as good as its execution.
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