Patients admitted to the Hospital at Home program offered by Presbyterian Healthcare Services in Albuquerque, N.M., have the same clinical outcomes as their inpatient peers, although their length of stay is shorter. 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.
Presbyterian, an eight-hospital system integrated with a health plan, a network of employed physicians, home care and a hospice program, serves as the learning laboratory for the Hospital at Home model developed by Bruce Leff, M.D., an internist at the Johns Hopkins University School of Medicine, Baltimore.
The at-home admission is offered to patients with certain diagnoses — chronic heart failure, chronic obstructive pulmonary disease, cellulitis and several others — who are sick enough to be admitted to the hospital, but do not require intensive care services.
A registered nurse and an aide each visit the patient one or two times a day, a physician makes a daily house call, and video monitoring provides around-the-clock oversight. Rehabilitation therapists and social workers show up at the patient's home, if needed, and the program arranges for infusions, mobile diagnostics, oxygen and other equipment and services to be delivered.
"There is a very strong evidence base that this is better care," Leff says. "This is the Triple Aim on steroids."
He and Cryer share a frustration that the Centers for Medicare & Medicaid Services does not reimburse hospitals for Hospital at Home admissions, although they hope that will eventually change. Earlier this year, Presbyterian applied for a Center for Medicare & Medicaid Innovation challenge grant, and some of the recently appointed CMMI advisers are pushing Hospital at Home initiatives.
Presbyterian was able to launch Hospital at Home because its integrated health plan recognized value when it was presented. The health system created a bundled payment that includes all components — medical services, physician services, therapy, diagnostics, durable medical equipment and anything else — and offered a discount to the insurer.
Scott Shannon, the program's finance director, says Presbyterian had the data in hand to create a win for all parties. "We were willing to accept a discounted price because we had been tracking our costs," he says.