It is not irrational that one of my biggest fears is being in the hospital. People die there.
I don’t mean that as a too-obvious black joke. I mean, people die there all the time of things they are not in the hospital for: MSRA infections, Clostridium difficile, novoviruses, SARS – things that antibiotics increasingly cannot treat.
So far, I’m healthy enough that a hospital stay is not in my immediate future. But that can change for anyone in a heartbeat (literal and figurative) and the older we get the more likely it becomes.
Which is why I was fascinated to read a story from Kaiser Health News about “hospital at home” which provides exactly what it says: hospital-quality care at home for patients with serious medical conditions that has proven, in many cases, to be superior to hospital care:
“In a study of three experimental hospital at home programs published in 2005 in the Annals of Internal Medicine, [Dr. Bruce] Leff [the director of geriatric health services research at Johns Hopkins School of Medicine in Baltimore who pioneered the concept] demonstrated that patient outcomes were similar or better, satisfaction was higher and costs were 32 percent less than for traditional hospitalizations.”
Hospital at home is still in its infancy but the trend is growing and more results are being collected and evaluated.
Presbyterian Home Health Care, an eight-hospital system in Albuquerque, New Mexico, manages the largest hospital at home program in the U.S. based on the original concept developed by Dr. Leff. Reports Hospitals and Health Networks magazine:
”Patient satisfaction scores are high and in the first six months of 2011, only one of the 100 patients treated at home was readmitted within 30 days…
“But the best news for those worried about high health care costs is this: ‘After three years of providing actual hospital-level care at home for the diagnoses included in this program, the cost per episode is $1,000 to $2,000 cheaper than if that care were delivered in the hospital,’ says Lesley Cryer, R.N., executive director of Presbyterian Home Healthcare.”
Currently, Presbyterian offers home care for patients being treated for chronic heart failure (CHF), chronic obstructive pulmonary disease (COPD), community-acquired pneumonia (CAP), cellulitis, complex urinary tract infection (UTI), dehydration, nausea and vomiting, deep vein thrombosis (DVT), and stable pulmonary embolism (PE).
”Excluded are patients who are medically unstable or who cannot be cared for adequately at home,” reports Kaiser Health News.
“’The patient, the family, the nurse, the doctor and the referring physician all need to feel if it’s safe,’ said Dr. Scott Mader, clinical director of rehabilitation and long-term care at the Portland VA Medical Center, which recently treated its 1,000th hospital at home patient.”
“If patients take a turn for the worse, for instance developing chest pain, an ambulance is summoned to take them to the hospital.”
The hospital at home idea is already being adopted in Australia, England, Israel and Canada. In the U.S., the Veterans Administration is leading the way with hospital at home programs existent or planned to open soon in Portland and Bend, Oregon, Boise, Honolulu, New Orleans and Philadelphia.
Even so, development of more hospital at home programs is slow. One of the main obstacles is Medicare’s reluctance to pay for this kind of service which frustrates administrators who are seeing successful medical outcomes, patient satisfaction and lower costs across the board.
“Traditional fee-for-service Medicare does not pay for hospital at home services, although individual private Medicare Advantage plans may do so,” says Kaiser Health News.
“The Centers for Medicare and Medicaid Services ‘appears convinced it’s going to add to overall costs’ and fearful that providers will admit patients inappropriately, said Erin Denholm, chief executive of Centura Health at Home, a division of Colorado’s Centura Health.”
However, Presbyterian has applied for a Center for Medicare & Medicaid Innovation challenge grant for hospital at home trials in Illinois, Rhode Island, New York, Florida and Minnesota. Some other health care systems are planning programs in other communities.
“‘It’s a very successful model and in five years, I think it’s going to be very common. But we’re still in the early adoption phase,’ said Mark McClelland, an assistant professor at the Center for Health Care Quality at George Washington University.”
Medicare won’t adopt this too soon for me.
There is an well-written study on hospital at home projects published last summer by The Commonwealth Fund here.
At The Elder Storytelling Place today, Mochael Gorodezky: The Hall (Any coincidence with my post today is just that, coincidence. – RB)