Provider Spotlight: Dr. Mandel, ER Maverick & Locum Tenens Physician

Dr. Ken’s Corner: Hospital Care At Home Picks Up Speed

Propelled, in part, by the pandemic and a subsequent shortage of hospital beds, the Centers for Medicare and Medicaid Services (CMS) has now given 56 hospitals the green light to provide hospital care at home. The concept has actually been around for some time, but is finally attracting vital support — not just from hospitals and the federal government, but from investors as well.

Simply stated, hospitals were designed to care for individuals who require complex diagnostic and treatment procedures — requirements that can only be addressed inside the walls of a hospital. Many hospitals have now discovered that some health problems for which patients are often hospitalized can be taken care of in the comfort of the patient’s home, as long as appropriate staffing and support systems are in place. Urinary tract infections, congestive heart failure, cellulitis, and COPD are examples of illnesses that may be treated in the home instead of in the hospital.

In 1994, Johns Hopkins became the first hospital system to establish a hospital-at-home program. The Johns Hopkins Model was originally created as a way to treat elderly patients who either refused to go to the hospital or were at risk of adverse events such as hospital-acquired pneumonia.

According to an article published by the Commonwealth Fund, Johns Hopkins found that the total cost of hospital-at-home care was 32% less than traditional hospital care, the length of stay for patients was shorter by one-third, and the incidence of health-related complications was dramatically lower. Plus, patients and their families were more satisfied. (See “Hospital at Home Programs: Step by Step” for a detailed description of the Johns Hopkins Model.)

From a reimbursement standpoint, hospitals participating in the rapidly growing CMS initiative must meet certain requirements. For example, before starting care of a patient in the home setting, there must be an in-person evaluation of the patient by a physician. Plus, a registered nurse must perform daily evaluations on each patient, either in person or remotely.

By all indications, hospital care at home has a promising future. According to a recent Wall Street Journal article, “Investors are financing a drive to shift hospital services into patients’ homes, banking on a future in which a growing amount of care occurs outside medical centers.” The Mayo Clinic and Humana are among those backing the ventures.