COVID-19 patients leave hospitals to be treated at home

As hospitals care for people with COVID-19 and try to keep others from catching the coronavirus, more patients choose to be treated where they are safest: at home.

In the U.S., “hospital at home” programs begin as the pandemic drags on, thanks to communications technology, portable medical equipment, and teams of volunteer 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. And they stand to become more popular with consumers who are connected to home delivery and other convenience on the internet.

Qualifying patients are typically acutely ill with common conditions such as chronic heartbeat, respiratory diseases, complications of diabetes, infections and even COVID-19. But they do not need the intensive care around the clock.

Instead, patients are connected to 24/7 command centers via video and surveillance devices that transmit 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 over the last 25 years shows that patients recover faster, have fewer complications and are satisfied, while costs can be one-third lower.

Doctors, hospital officials and patients share other benefits: Patients get more rest when they sleep in their own bed. They can eat whatever they want, start moving faster and go to fresh air. They will fall less if they are in familiar surroundings, where they have support from family and even pets.

“I would highly recommend it to anyone staying home,” said William Merry, who contracted pneumonia at his home in Ipswich, Mass., In July. “There was never a problem. Never.”

Merry, who underwent an uncomfortable hospital stay six years ago, refused another one when antibiotic pills did not improve his lung infection and his temperature hit 103. That regulated his doctor’s care through Boston-based Medically Home.

Nurse Sadie Paez inspects medical equipment in William Merry’s dining room.

(Elise Amendola / Associated Press)

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, and had them explain 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 COVID-19 pandemic appeared earlier this year, some hospitals devised home care programs to accommodate temporary patient spikes and 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, Tenn-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 the company has added care to ‘allow’ patients from emergency care and cancer clinics.

Another company, DispatchHealth, previously focused 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. After piloting a hospital-home program in November, it now has programs running in three cities and is planning a 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.

Nurse Sadie Paez uses a stethoscope to listen to William Merry’s chest. Merry has recovered from pneumonia at his home.

(Elise Amendola / Associated Press)

Meanwhile, hospitals with existing programs are seeing far more patients opting for home care.

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.

The hospital-home model has been used on a small scale in the U.S. since the mid-1990s, she said, but it was held back because many insurance plans, including traditional Medicare, do not provide such treatment. fully covered.

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.

It now treats patients for 10 hospitals and one group of physicians in five states, including two that were established shortly after the pandemic hit. Two Mayo Clinic hospitals participated this summer. Medically, Home would have to operate in 12 states by early 2021, Rakowski predicts.

He said 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, which served 1,120 veterans last year.

More veterinarians are using the program during the pandemic, said Dayna Cooper, head of the agency’s home programs. One of the busiest, in San Antonio, saw a 90% jump in veterans being treated this March to June compared to last year.

Another four of the agency’s 170 hospitals are working on programs to begin. Cooper said research from the programs in Cincinnati and Honolulu found that they cut costs by 29 percent to 38 percent, without requiring 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, Leff said, “I think most hospitals will return to normal.”