Being Treated at Home Can Help People Save Money and Heal Faster

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  • A new study found that the home hospital model can potentially improve care while reducing costs.
  • The cost of care was nearly 40 percent lower.
  • Trial participants receiving hospital care in their homes had a 70 percent lower rate of readmission to the hospital.

People check into a healthcare facility expecting to have better, but you can find risks — and some even find yourself getting sicker.

You can face the risk of complications, like bleeding or infection. Additionally, there are the constant check-ins from nurses or physicians that could disrupt sleep.

And none of that features the cost.

Additionally, when in a hospital, individuals are stuck in their hospital beds and many experience negative health impacts out of this physical inactivity.

However, a pilot study by investigators at Brigham and Women’s Hospital in Boston finds that the home hospital model could improve care while reducing costs. The findings were published in Annals of Internal MedicineTrusted Source today.

“Hospital at Home (HaH) since the name states, cares for hospital-eligible patients at home. Models vary, but generally patients noticed in the emergency room that want hospital-level care receive the choice of intensive care at home,” said Thomas Cornwell, MD, founder of Northwestern Medicine HomeCare Physicians and chief executive officer, Home Centered Care Institute (HCCI).

First study of its kind

“To date, there’s not even been a randomized controlled trial of home hospital care performed in the U.S. other than our small pilot,” David Levine, MD, MPH, MA, the study’s corresponding author, told Healthline.

The outcome of Dr. Levine and team’s randomized controlled trial (RCT) can strengthen the case for home hospital care, showing that it reduces costs and readmissions while increasing physical exercise in contrast to usual hospital care.

“We wanted showing with a very high amount of evidence that home hospital care could be brought to acutely ill adults with cheaper, better physical exercise, high quality and safety, and excellent patient experience,” said Dr. Levine.

“Furthermore, we feel this provides all Americans the data they require to find the look after themselves and their family members should they require
hospitalization,” he said.

Cost of care was nearly 40 percent lower

Levine and team enrolled 91 adult patients to the trial.

Each participant have been admitted via the emergency department at Brigham and Women’s Hospital or Brigham and Women’s Faulkner Hospital with acute problems that included infection, worsening heart failure, worsening chronic obstructive pulmonary disease (COPD), and asthma, that lived within 5 miles of the hospital.

They certainly were randomized either to keep at a healthcare facility for standard care or for care at home, including nurse and physician visits, intravenous (IV) medications, remote monitoring, video communication, and point-of-care testing.

Researchers measured the sum total direct cost of care, including costs for nonphysician labor, supplies, tests, and medications.

The findings indicate that patients receiving at-home care had total costs that have been almost 40 percent lower than for patients treated conventionally.

“This study shows better outcomes for a cheaper as well as an improved use of resources. That is promising work and more and more attention will be paid to hospital care at home,” said Melissa O’Connor, PhD, MBA, RN, FGSA, and director, Geriatric Interest Group, Villanova University, M. Louise Fitzpatrick College of Nursing.

“However, further work is needed to determine the kind of patient this best works for related for their severity of illness,” she said. “Do they require a caregiver? Do they must be cognitively intact? What type of home environment is needed?”

70 percent lower readmission rate

In line with the study, those at home had fewer lab orders, less imaging (like X-ray and MRI), and had fewer consultations.

Levine and team also unearthed that home hospital patients were less sedentary, and even had lower readmission rates within 30 days than patients admitted to hospital care.

“We also realize that patients move more during a house hospitalization, which we believe goes quite a distance toward healing,” said Dr. Levine.

The research was actually stopped early on as a result of strength of the findings.

“We didn’t build our home hospital study as a readmission reduction program, but one of the more surprising findings was how impactful home hospital care was on 30-day readmission,” said Levine. “Seven percent of home hospital patients, in comparison to 23 percent of traditional hospital patients, were readmitted at 30 days — nearly a 70 percent reduction!”

“Receiving care at home produces

Home care is a tailored experience — but who pays?

a truly tailored experience,” emphasized Dr. Levine. “The answers to questions such as, ‘which medicines are you currently taking,’ or ‘what do you really need help with during an average day,’ and ‘what’s in your kitchen’are typically discussed only when at home and have profound health and healing effects.”

But Dr. Cornwell remarked that Medicare and Medicaid won’t adequately cover the expense of hospital at home.

“There’s not just a separate fee-for-service payment for HaH. There are no specific codes for it. You would have to use the current house call codes which don’t cover all the cost,” Dr. Cornwell said.

“It could be like charging each day in a healthcare facility having an office visit code. Today, those participating are systems that have at-risk contracts. Because they are on the hook for many medical costs, they benefit from the lower costs of HaH and the higher outcomes and patient satisfaction,” he continued.

The bottom line

There are disadvantages to in-hospital care that could increase health problems, but a new clinical trial finds that providing hospital quality care in the home may reduce these risks and improve patient outcomes.

Trial participants receiving hospital care in their homes had a 70 percent lower rate of readmission to the hospital.

Although at-home care can reduce hospital costs and improve patient health, many medical health insurance providers, especially Medicare and Medicaid, still won’t cover the expense of home-based hospital care.

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