Although changes often come slowly in healthcare, we are now in the midst of the following three major changes in the field: (1) reduction in inpatient admissions that is driving the growth of bedless or mini-hospitals; (2) provision of first-tier outpatient care in walk-in clinics such as CVS/MinuteClinics; (3) the transfer of some inpatient care to patients' homes, partly as a cost-reduction strategy. This latter topic was previously covered in one of my blog notes (see: Some Details about Hospital-at-Home (HaH) Services for Selected ER Patients) and also in a recent article (see: Commentary: Reducing the cost of acute care by going home). Below is a quote from the latter:
An ideal way to...[reduce healthcare costs while increasing quality] is to keep patients out of the hospital whenever possible through proactive, preventive care. Yet even when this fails and patients do need acute care, we can successfully treat many of them outside the hospital. Hospital at Home is an innovative program that provides hospital-level service in the patient's own home, at a fraction of the cost of hospitalization. Health systems across the country are prepared to launch such programs, which would save Medicare hundreds of millions of dollars, once an appropriate payment model is in place. Elderly patients with illnesses such as pneumonia, asthma and urinary tract infections, can be treated at home where they face less risk of falling, sleep better, receive better nutrition, and are far less exposed to drug-resistant bacteria, all of which contribute to better outcomes and greater patient satisfaction....
The acute-care team includes doctors and nurse practitioners who provide a daily visit and are on call 24/7. Nurses visit twice a day. Social workers, physical therapists and other providers are available as needed. The program brings portable medical equipment to the home, including X-ray machines, electrocardiograms, infusion pumps, and ultrasound machines, while state-of-the art communications technology can supplement in-person visits to ensure the patient is well-monitored. If clinical concerns develop, the patient is quickly brought to the hospital. Following the acute-care episode, a 30-day period of transition services provides a smooth discharge and appropriate support.
One of the reasons that home care as a substitute for some inpatient care makes so much sense, in addition to being less expensive, is that modern telecommunications technology can provide physiologic monitoring of the home-based patient. All of this reminds me of tele-ICU which is defined in the following way (see: Tele-ICU: Efficacy and Cost-Effectiveness Approach of Remotely Managing the Critical Care): Tele-ICU...[is based on the idea of] an off-site command center in which a critical care team (intensivists and critical care nurses) is connected with patients in distant intensive care units (ICUs) through a real-time audio, visual and electronic means and health information is exchanged.
This concept of tele-ICUs has been in vogue for a number of years for health systems with smaller hospitals and a small number of intensive care beds. These critical-care patients were monitored by intensivists located at command centers in one of the larger hospitals in the same system. I first blogged about this concept eight years ago (see: Telemedicine Transforms Intensive Care Units in Smaller Hospitals with Remote Monitoring). Another reason why the Hospital at Home concept is so appealing is that CMS will now reimburse for remote patient monitoring (see: New CMS Reimbursement Guidelines: Support for Provider-to-Provider Consults.
Comments