Some Patients Can Choose To Be Hospitalized At Home

The Kaiser Health News reports: Some Patients Can Choose To Be Hospitalized At Home.

Find the article, produced in collaboration with USA Today, written by Judith Graham (May 29), at http://www.kaiserhealthnews.org/Stories/2012/May/30/Graham-Hospital-At-Home.aspx.

KHN reports that "Hospital at home" programs fundamentally refashion care for chronically ill patients who have acute medical problems -- testing traditional notions of how services should be delivered when people become seriously ill.

There are a small number of these initiatives in place in the US: an Albuquerque, NM program, run by Presbyterian Healthcare Services (and highlighted by the KHN report), and programs in Portland, Ore., Honolulu, Boise, Idaho, and New Orleans offered through the Veterans Health Administration.

The concept has been adopted in Australia, England, Israel and Canada.

KHN says that “hospital at home” programs are getting attention in the US “with increased pressure from the national health overhaul to improve the quality of medical care and lower costs.”

According to research led by Dr, Bruce Leff, the director of geriatric health services research at Johns Hopkins School of Medicine in Baltimore who pioneered the concept, “hospital at home” programs can do both: improve care and lower costs.

In a study of 3 experimental “hospital at home” programs published in 2005 in the Annals of Internal Medicine, Leff demonstrated that patient outcomes were similar or better, satisfaction was higher and costs were 32 percent less than for traditional hospitalizations.

Go here to find Dr. Leff's study: http://www.annals.org/content/143/11/798.abstract.

KHN predicts that the model will become more common. Last year, the Cochrane Collaboration, an international organization that evaluates the evidence supporting health care interventions, published a review of 10 randomized controlled studies on hospital at home programs. That report reportedly “found that 38 percent fewer patients in these programs had died after six months, compared to those who underwent traditional hospitalizations.” 

Go here to find the Cochrane report: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007491/abstract.

So what’s the problem? KHN reports that “Resistance from Medicare and private insurers is the biggest problem these programs face. Traditional fee-for-service Medicare does not pay for hospital at home services, although individual private Medicare Advantage plans may do so.” And then, for physicians, “doing hospital-level services at home sounds scary… and a big jump.”

But, according to KHN: “That may change” as hospitals and doctors form accountable care organizations (ACOs) that are promoted in the health care overhaul and call for providers to restructure how medical care is delivered.”