Coronavirus pandemic pushes expansion of ‘hospital-at-home’ treatment

As hospitals treat people with COVID-19 and try to prevent others from catching the virus, more and more patients are choosing to be treated where they feel safest: at home.

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Across the United States, “hospital-at-home” programs are taking off amid the pandemic, thanks to communication technologies, portable medical equipment and teams of doctors, nurses, radiology technicians and paramedics. . This reduces the strain on medical centers and allays the fears of patients.

The programs represent a small slice of the roughly 35 million hospitalizations in the United States each year, but they are growing rapidly thanks to increases in Medicare and private insurers. Like telemedicine, the concept is set to become more popular with consumers keen on home delivery and other Internet-connected amenities.

Eligible patients are typically critically ill – but don’t need 24-hour intensive care for – common conditions such as chronic heart failure, respiratory disease, complications from diabetes, infections, and even COVID- 19.

They are linked to the 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 on such programs around the world over the past 25 years shows that patients recover faster, have fewer complications and are more satisfied, while costs can be one-third lower.

Doctors, hospital officials, and patients tout other benefits: People get more rest by sleeping in their own beds. They can eat whatever they want, move faster, and get outside for some fresh air. They are less likely to fall into their familiar surroundings, where they have the support of family and even pets.

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“I would definitely recommend anyone to be able to stay at home,” said William Merry, who received treatment for pneumonia in July at his home in Ipswich, Massachusetts. “There has never been a problem. Never.”

Merry, who had endured an uncomfortable hospital stay six years ago, refused another when antibiotic pills did not help and his temperature rose to 103. Her doctor therefore arranged for treatment by the. Boston-based Medically Home intermediary.

Joyeux and his wife Linda, a retired nurse, said they were amazed at how quickly the ward transformed their dining room into a mini hospital room. Technicians set up medical equipment, gave them supplies and oxygen tanks, then explained how everything worked.

It relieved their stress, as did the regular video calls with a doctor. They had daily schedules listing scheduled visits by medical staff, blood work, tests, administration of intravenous drugs and other care, she said.

“I think it’s really important,” she warned, “that the person has someone who can be home.”

Dr Bruce Leff, professor of geriatrics at the Johns Hopkins School of Medicine and pioneer of home hospitals, did pilot studies years ago. He found benefits for the elderly patients who, as he said, “were basically going to be run over by the hospital” because of the risks of developing blood clots and infections, losing mobility and developing delirium. .

Even before the coronavirus pandemic emerged earlier this year, some hospitals were considering home care programs to absorb peaks in temporary patients – and avoid the high cost of new buildings.

It’s unclear how many U.S. programs exist, but when COVID-19 hit, some institutions rushed to sign up for Medically Home and similar services.

Contessa Health, based in Nashville, Tennessee, which serves 14 hospitals in six states, announced the addition of two more hospitals shortly and is negotiating potential contracts for about 20 more. Patient volume has jumped 140% from last year and this is additional care for patients “admitted” from emergency care and cancer clinics.

Another company, DispatchHealth, previously focused primarily on preventing emergency room visits by urging paramedics to provide diagnostic tests, medication and other care in patients’ homes or elsewhere. The Denver-based company says it has signed more than 200 contracts with insurers in 19 U.S. markets to treat critically ill and injured people at home. It piloted a home hospitalization program in November, already has programs underway in three cities, and plans to expand rapidly.

Some hospitals have set up their own home programs. At the end of March, eight of 36 hospitals in the Atrium Health system in the Carolinas and Georgia opened one for patients with COVID-19 who do not need intensive care. It has already treated around 11,000 people.

Meanwhile, hospitals with existing programs are seeing many more patients choosing home care.

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In New York City, the Mount Sinai at Home program has grown from 10 patients per month to 30, said director Dr Linda DeCherrie. The program has since added a twist in which patients begin care inside the hospital and then end up at home.

“Everyone we proposed it to said yes,” DeCherrie said.

DeCherrie said the home hospital model had been used on a small scale in the United States since the mid-1990s, but was chosen because traditional Medicare and some insurance plans did not fully cover it. treatment.

But when the pandemic struck, the Centers for Medicare and Medicaid Services temporarily let hospitals bill for care outside of their walls, including at patients’ homes. Many private insurers are also covering home hospital care during the pandemic. Hospital groups and others want Congress to make these changes permanent, along with hospital care.

Raphael Rakowski, co-founder of Medically Home, 4, said the number of patients treated in July was tenfold compared to July 2019.

“Our business is exploding because of COVID,” he said.

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He now treats patients for 10 hospitals and a group of doctors in five states, including two that were set up shortly after the outbreak of the pandemic: Tufts Medical Center in Boston and hospitals on the west coast of Adventist Health. Two Mayo Clinic hospitals joined this summer. Medically Home is expected to operate in 12 states by early 2021, Rakowski predicts.

He says some patients are offered home care after being seen in an emergency room. In other cases, doctors organize care for patients who receive cancer treatment, those who have sudden illness, some are about to have surgery, or patients discharged home with complications. dangerous.

The Veterans Health Administration operates 12 home hospital programs. Last year they served 1,120 veterans.

More vets are using the program during the pandemic, said Dayna Cooper, the agency’s home programs manager. One of the busiest, in San Antonio, saw a 90% increase in the number of veterans treated from March to June compared to last year.

Four more of the agency’s 170 hospitals are working to start programs. Cooper said studies of the programs in Cincinnati and Honolulu found they cut costs by 29% to 38%, with no difference in hospital survival or readmission.

Although interest in the programs has skyrocketed, whether home hospital care will flourish after the pandemic depends largely on whether the government and private insurers continue to cover it at cost-effective prices.

If they don’t, Johns Hopkins’ Leff said, “I think most hospitals will get back to normal.”

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