Lengthy hospital stays are often infamously derided for their seemingly exorbitant price tags, unsavory-yet-overpriced food, and general patient dissatisfaction with their perceived level of quality of care. In all honesty, these sentiments --while potentially valid-- are also often somewhat unfair, and worsened by a lack of transparency and understanding of the basic economics that go into maintaining a viable hospital system operational, particularly within our current medico-legal environment. All that notwithstanding, there are very legitimate reasons for someone to search for alternative solutions to long-term care that are better suited to both the patient and their family’s lives. One of these potential alternatives is “hospitalization” at home.
Many hospitals and emergency departments (EDs) across the country are facing serious shortages of available hospital beds for inpatient care. As a result, many ED’s are stuck “boarding” patients in hallways for days or even weeks while they await a hospital bed to open up. Obviously, this is less than ideal for myriad reasons: it is uncomfortable and unpleasant for the patient; it increases potential exposure to pathogens and the development of new hospital-acquired infections; it increases wait times in EDs; and so forth.
Fortunately, the Centers for Medicare and Medicaid Services (CMS) actually have expanded their Hospitals Without Walls initiative by creating the Acute Hospital Care at Home (AHCAH) program, which financially covers “hospitalization” at home. This program allows patients to remain in their homes with daily follow-up by healthcare providers, as the situation warrants. This daily follow-up can range from in-person nurse or physician visits (to administer medications, maintain intravenous (IV) lines, perform examinations, etc,), all the way to even virtual check-ins by a clinician to make sure everything is going well.
As one would assume, there are limitations to this program. The patient must be sufficiently ill to have otherwise warranted normal hospitalization. However, their condition must also be sufficiently low in severity and stable that they do not require immediate access to the lifesaving resources found in a physical hospital. The patient must be able to perform the basic activities of daily living, or at least have reasonable assistance available for certain limitations. Furthermore, admittance to the program requires an in-person evaluation from a physician. This can be performed in an ED or community clinic, where the physician determines the individual warrants hospitalization, but is safe to be admitted to the home hospitalization program. Alternatively, if the patient is already admitted to the hospital, their hospital physician may determine that they are stable enough to continue their “hospitalization” at home. The home must also be assessed to ensure it is a safe environment and meets basic criteria such as running water, indoor plumbing, heating and/or air conditioning, etc. A member of the clinical team must also meet with the patient at their home to go over the entire treatment plan and assess what additional steps might need to be taken (such as providing meals, for example).
Ideally, this program should offer greater convenience and comfort to suitable patients, while also reducing the inpatient costs and overcrowding burdens on the healthcare system. There are currently 53 health systems with 116 hospitals located across 29 states that have been approved for this program. To see if a hospital near you is participating in the program, you can check the following list published by CMS.
Theoretically, home hospitalization programs could help alleviate hospital crowding and extended ED “boarding” stays, in addition to possible savings on healthcare expenses. A study from Johns Hopkins found that home hospitalization cost roughly 32% less than traditional hospital care (an average difference of $5,081 vs. $7,480 for applicable hospitalizations). However, other studies have failed to show any significant difference in the average costs of home hospitalization vs. inpatient care. One might also worry about many possible unintended and unwanted consequences of a program such as this. For example, if it becomes easier for busy ED physicians to simply clear out patients by sending them back home under this program, you might find that the home hospitalization program becomes inappropriately overused, ultimately driving CMS costs up instead of down. The program might also be abused from the consumer side, where individuals seek out the comfort and/or benefits of this service inappropriately. Again, driving total costs up instead of down. However, for the time being, it is a potentially promising program that will undoubtedly need further tweaking as it matures.
If you or a loved one is facing a possible hospitalization --or are/is currently hospitalized-- consider asking your physician if their hospital is participating in a home hospitalization program and whether that is a suitable option for your treatment.
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