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As hospitals care for people with COVID-19 and try to keep others from catching the virus, more patients choose to be treated where they are safest: at home.
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In the US, “hospital at home” programs begin amid the pandemic, thanks to communications technology, portable medical equipment and teams of doctors, nurses, X-ray techs and paramedics. This reduces penalties at medical centers and reduces patients’ fears.
The programs represent a small chunk of the roughly 35 million U.S. hospitalizations each year, but they are growing rapidly with boosts from Medicare and private health insurers. Like telemedicine, the concept is becoming more popular with consumers connected to home delivery and other internet-connected convenience.
Eligible patients are typically acutely ill with – but not over – intensive care – general conditions including chronic heartbeat, respiratory disease, complications of diabetes, infections and even COVID-19.
They are connected to 24/7 command centers via video and surveillance devices that send their vital signs. They receive several daily home visits from a dedicated medical team. Just like in a hospital, they can press an emergency button at any time for immediate help.
Research into such programs around the world over the past 25 years shows that patients recover faster, have fewer complications and are satisfied, while costs can be a third lower.
Doctors, hospital officials and patients offer other benefits: People get more rest to sleep in their own bed. They can eat whatever they want, start moving faster and go to fresh air. They fall less into their familiar environment, where they have support from family and even pets.
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“I would highly recommend it to anyone to stay home,” said William Merry, who was diagnosed with pneumonia at his home in Ipswich, Massachusetts, in July. “There was never a problem. Never. “
Merry, who had undertaken an uncomfortable hospital stay six years ago, refused another one when antibiotic pills did not help and his temperature hit 103. That his doctor arranged care through Boston-based Medically Home.
Cheerful and Mrs. Linda, a retired nurse, said they were shocked at how quickly the service turned their dining room into a mini-hospital room. Technicians set up medical equipment, provided their supplies and oxygen tanks, then explained how everything worked.
That required her stress, as did regular video calls with a doctor. They received daily schedules with scheduled visits from medical staff, blood tests, tests, IV medicine administration and other care, she said.
“I find it really important,” she warned, “that the person has someone who can be at home.”
Dr. Bruce Leff, a geriatrics professor at the Johns Hopkins School of Medicine and a pioneer of hospital at home, conducted pilot studies years ago. He found benefits for elderly patients who, as he said, would otherwise “in principle” be crushed by the hospital “because of risks of developing blood clots and infections, losing mobility and developing delirium.
Even before the coronavirus pandemic erupted earlier this year, some hospitals considered home-care programs to accommodate temporary patient spikes – and to avoid the high cost of new buildings.
It is unknown exactly how many US programs exist, but when COVID-19 hit, some institutions advised them to sign up with Medically Home and similar services.
Nashville, Tennessee-based Contessa Health, which serves 14 hospitals in six states, says it recently added two hospitals and is negotiating potential contracts for about 20 more. Patient volume has jumped 140% since last year and it has added care for patients ‘admitted’ from emergency care and cancer clinics.
Another company, DispatchHealth, previously focused primarily on preventing ER visits by rushing paramedics to provide diagnostic tests, medications and other care at patients’ homes than anywhere else. The company in Denver says it has 200-plus contracts with insurers in 19 U.S. markets to treat seriously ill and injured people at home. It piloted a November hospital program, already has programs running in three cities and plans rapid expansion.
Some hospitals have installed their own home programs. At the end of March, eight of the 36 hospitals of the Atrium Health system in the Carolinas and Georgia started one for COVID-19 patients who did not require intensive care. It has already treated about 11,000 people.
Meanwhile, hospitals with existing programs are seeing far more patients opting for home care.
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In New York, the Mount Sinai at Home program went from treating 10 patients a month to 30, said its director, Dr. Linda DeCherrie. The program has since added a twist in which patients begin care in the hospital, and then finish off at home.
“Everyone we offered said yes to,” DeCherrie said.
DeCherrie said the hospital-home model has been used on a small scale in the U.S. since the mid-1990s, but it was held back because traditional Medicare and some insurance plans do not fully cover such treatment.
But when the pandemic hit, the Centers for Medicare and Medicaid Services temporarily billed hospitals for care outside their walls, including in patients’ homes. Many private insurers also insure hospital care during the pandemic. Hospital groups and others want Congress to make those changes permanent, at the same rates as hospital care.
Raphael Rakowski, co-founder of 4-year-old Medically Home, said the number of patients treated this July has increased tenfold since July 2019.
“Our business is exploding because of COVID,” he said.
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It now treats patients for 10 hospitals and one group of physicians in five states, including two that were set up soon after the pandemic hit: Boston’s Tufts Medical Center and Adventist Health’s West Coast hospitals. Two Mayo Clinic hospitals participated this summer. Medically, Home would have to operate in 12 states by early 2021, Rakowski predicts.
He says some patients are offered home care after being examined in an emergency room. In other cases, physicians prescribe care for patients receiving cancer treatment, those with a sudden illness, some seeking surgery, or homebound patients with dangerous complications.
The Veterans Health Administration operates 12 hospital-home programs. Last year, they served 1,120 veterans.
More veterinarians are using the program during the pandemic, said Dayna Cooper, head of agencies’ home programs. One of the busiest, in San Antonio, saw a 90% jump in veterans being treated this March to June versus last year.
Another four of the agency’s 170 hospitals are working on programs to begin. Cooper said studies of the programs in Cincinnati and Honolulu found that they cut costs by 29% to 38%, with no differences in survival or hospitalization.
Although interest in the programs has grown again, the question of whether hospital care after the pandemic depends to a large extent on whether the government and private insurers continue to do so at cost-effective rates.
If they do not, Johns Hopkins’ Leff said, “I think most hospitals will return to normal.”
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