Hospital At Home! What Is It?

In September 2021, Joy Goehert started experiencing symptoms of a severe urinary tract infection. She went to UMass Memorial Hospital and was hospitalized for five days. Goehert was home for only four days when she had a relapse and returned to the hospital.

Goehert had to wait in the emergency room for a while until she was placed in a ward. The following morning, a nurse spoke with her about UMass’s Hospital at Home program, which allows patients to receive hospital care at home. Goehert said she was leery about it at first, but she gave it another thought.

“Who wants to be in the hospital when you can be at home?” Goehert said. “I was quite happy to say yes.”

A system was set up at her house that included a nurse visiting twice a day, communication with her doctor via a tablet, and a monitor on her arm that took certain readings and calls to ensure her equipment was working.

Goehert said the best part of being at home instead of in the hospital was the food, her husband, and sleeping in her own bed, which is “far superior to hospitals.”

What was also “far superior,” Goehert said, was the quality of care she received in the Hospital at Home program. “It’s a wonderful world being at home,” she added.

Through the Hospital at Home program, healthcare systems like UMass are bringing hospital-level care to their patients’ homes.

With annual hospital care services rising to over $1 trillion and hospitals reaching bed capacity—not to mention patients’ frustrations with hospitals—healthcare systems have been exploring more efficient and economical ways to deliver care.

In recent years, studies have found that Hospital at Home programs lower the risks of infections patients may get while hospitalized, lower the risk of hospital readmissions, and provide better rest for patients, among other things.

Patients in Hospital at Home programs can also receive the same tests as they would in the hospital, such as an electrocardiogram, echocardiogram, and x-rays. They can also receive treatments, including oxygen therapy, intravenous fluids, intravenous antibiotics, and other medicines.

Hospital at Home programs grew exponentially during the COVID-19 pandemic when people with chronic illnesses, but not the coronavirus, avoided going to the hospital. So far, the Centers for Medicare and Medicaid Services (CMS) has authorized 320 hospitals across 133 health systems in 37 states to offer acute hospital care at home.

With the capacity to treat 70 patients in their home, the Mass General Brigham healthcare system, based in Somerville, Mass., is the largest home hospital in the country, according to Mass General Brigham President and CEO Dr. Anne Klibanski.

Other large healthcare systems operating Hospital at Home programs include:

• Adventist Health (CA)
• Allegheny Health Network (PA)
• Atrium Health (NC)
• Baylor Scott and White Health (TX)
• Cleveland Clinic (OH)
• Mass General Brigham Healthcare System
• Medical City Healthcare (TX)
• Northwestern Medicine (IL)
• Novant Health (NC)
• ProMedica (MI and OH)
• Texas Health System (TX)

How Hospital at Home Programs Began

The Hospital at Home program was the brainchild of Johns Hopkins University School of Medicine. In 1995, the medical school posed a question: “Is there a way to provide high-quality hospital-level care in the home of acutely ill older adults that reduces health care costs while improving the patient experience?”

Johns Hopkins researchers launched studies to answer that question and were pleased with the results. Now, Johns Hopkins reports that Hospital at Home programs:

• Provide better health outcomes for patients
• Shortens patient’s length of stay
• Increase satisfaction among patients and their family members and reduce caregiver stress.
• Provide cost savings of 19 percent to 30 percent compared to traditional inpatient care

According to CMS, Hospital at Home patients have lower mortality rates and fewer complications compared with patients treated for similar acute conditions in hospitals.

Hospital at Home Guidelines

While there may be some differences in the way healthcare systems operate their Hospital at Home programs, there are general guidelines that are followed:

• An emergency department, ambulatory site, or community physician identifies a patient as being sick enough to be hospitalized but stable enough to be treated at home.
• Medical professionals use a list of eligible diagnoses to determine which patients would be good candidates for treatment. Congestive heart failure, chronic obstructive pulmonary disease (COPD), pneumonia, cellulitis, and certain skin infections are among the many illnesses eligible for the program.
• Eligible patients are given an explanation of the program and are assigned a physician.
• Some programs have a care team member who meets the patient at home. The doctor discusses treatment with the patient either in person or via video. Respiratory therapists, physical therapists, other medical staff, home health aides, and social workers may be assigned if needed. Nurses are available 24 hours a day, 7 days a week, for any type of emergency situation.
• Patients are treated until they are stable enough to be discharged.

Hospital at Home Companies

Hospital at Home could not function as well as it does without the help of companies that partner with healthcare systems to support the program. For instance, technology firms provide digital platforms allowing doctors and other medical providers to remotely communicate with their patients and collect and monitor their data. Companies offer many other tools, such as wearable devices that monitor a patient’s vital signs, pulse oximeters that measure the amount of oxygen in the patient’s blood, and personal emergency response devices that allow a patient to call for help in case of an emergency.

List of some of the larger companies that partner with healthcare systems to deliver Hospital at Home programs:

1. AlayaCare

AlayaCare offers a home healthcare software platform that helps home care providers and nurses access and track patients’ health and fitness.
https://alayacare.com/the-alayacare-platform/

2. American Well (Amwell) Corporation

Amwell, a telemedicine company that connects patients with doctors over secure video using a phone, tablet, or computer.
https://business.amwell.com/

3. Best Buy Health

Best Buy, a national retailer of consumer electronics, offers a care-at-home platform that connects patients with medical personnel. It also delivers, installs, and activates wearable technology that allows a patient’s vital signs to be monitored and is equipped with a personal emergency response system that allows a patient to call for help in case of an emergency.
https://www.bestbuyhealth.com/

4. Biofourmis

Biofourmis, a digital therapeutics company, uses its artificial intelligence-powered remote monitoring tools that allow health providers to monitor patients’ vital signs and review data to determine how a patient is doing.
https://www.beckershospitalreview.com/innovation/5-companies-partnering-with-hospitals-for-hospital-at-home-programs.html

5. BioIntellisense

BioIntellisense is a remote patient-monitoring company that provides a body sensor that can continuously monitor patient vital signs from home and deliver the data to healthcare providers.
https://www.beckershospitalreview.com/innovation/5-companies-partnering-with-hospitals-for-hospital-at-home-programs.html

6. Cadence

Cadence offers a remote care management platform for patients with chronic conditions. The company collects and analyzes patients’ vitals, medical histories, and wellness data from their homes to create personalized care plans.
https://www.beckershospitalreview.com/digital-transformation/lifepoint-inks-founding-partnership-with-new-remote-care-monitoring-company.html

7. Contessa

Contessa’s Recovery Care at Home systems helps health care systems build patient care teams.
https://contessahealth.com/solutions/recovery-care-at-home/

8. Health Recovery Solutions

Health Recovery Solutions offers remote, real-time, biometric monitoring of continuous body temperature, heart rate, respiratory rate, pulse oximetry, and ECG metrics. It also helps the provider and patient communicate through virtual visits, symptom surveys, medication reminders, and more.
https://www.healthrecoverysolutions.com/hospital-at-home#

9. MedArrive and Heartbeat Health

MedArrive is a healthcare logistics platform that connects patients with on-demand medical transportation and care. Heartbeat Health is a company that provides virtual cardiology services. A MedArrive nurse and emergency medical technicians assess patients in their homes and connect them with a cardiologist from Heartbeat Health to determine whether they need an immediate consultation.
https://www.advisory.com/daily-briefing/2023/08/16/hospital-at-home#

10. Peerbridge Health

Peerbridge Health has a wireless ambulatory electrocardiogram (ECG) patch that patients can wear at home to detect early signs of heart failure.
https://www.prnewswire.com/news-releases/peerbridge-healths-remote-device-for-early-detection-of-heart-failure-achieves-95-7-success-rate-in-trial-302105217.html

11. WellSky

WellSky is a home health software provider with technology that can view inside patients’ lungs so doctors can quickly assess lung fluid and intervene to prevent a patient’s hospital readmission.
https://www.beckershospitalreview.com/telehealth/osu-wexner-launches-hospital-at-home-program-for-patients-with-heart-failure.html

Hospital at Home Medicare

Medicare covers Hospital at Home costs, but the in-home program is not limited to older adults. Some private insurers and Medicaid cover program costs for patients under 65 years old.

During the COVID-19 pandemic in 2020, CMS launched a waiver program that allowed hospitals to provide inpatient hospital care for patients in their homes. The waiver also meant that CMS would reimburse hospitals for traditional Medicare services, and private insurers followed suit by reimbursing hospitals for Medicare Advantage plans.

The waiver is expected to expire on December 31, 2024, placing Hospital at Home programs in jeopardy, particularly among hospitals that depend on Medicare payments. Hospital groups and program providers want Congress to extend the waiver for five years. A bipartisan bill was introduced in May to extend the waiver through the end of 2029.

In the meantime, Mass General Brigham wants to move 10 percent of its medical patients to home care, Heather O’Sullivan, president of the system’s Healthcare at Home, said at a global health conference. “There’s actually research out there showing that 30% to 40% of all care provided in the U.S. today can be moved to the home.”

Video Links:

NBC NIGHTLY NEWS: At-home hospital programs offer possible solution to strained ERs

Hospital’s with Hospital at Home Programs near me

This is the latest list of approved Hospital at Home programs in their states.

Alabama

• University of Alabama (UAB) Hospital

Arkansas

• St. Bernards Medical Center
• University of Arkansas Medical Sciences

Arizona

• Dignity Health
• Mayo Clinic

California<

• Adventist Health
• Cedars-Sinai Hospital System
• Hoag Hospital Newport Beach
• Keck Hospital of USC
• Loma Linda University Medical Center
• Palomar Health
• Scripps Health
• Sharp Healthcare
• Stanford Healthcare
• UCI Health – University of California Irvine
• UCSF Medical Center
• University of California San Diego

Connecticut

• Yale New Haven Health

Delaware

• Beebe Healthcare
• ChristianaCare

Florida

• AdventHealth
• BayCare Health System
• Cleveland Clinic
• Health First
• Keralty Hospital (formerly Westchester Hospital)
• Lee Health
• Mayo Clinic
• Orlando Health
• Tampa General Hospital
• University of Florida

Idaho

• St. Luke’s Medical Center

Illinois

• Blessing Hospital
• Northwestern Medicine
• OSF Healthcare
• University of Chicago Medicine
• University of Illinois Health

Indiana

• Franciscan Health
• Indiana University Health

Iowa

• UnityPoint

Kentucky

• Appalachian Regional Healthcare
• Baptist Health Louisville

Louisiana

• Claiborne Memorial Medical Center

Maryland

• ChristianaCare

Massachusetts

• Boston Medical Center
• Lowell General Hospital
• Mass General Brigham
• Massachusetts General Hospital
• South Shore Health
• UMASS

Michigan

• Henry Ford Health System
• MidMichigan Health
• ProMedica
• University of Michigan Hospitals and Medical Center

Minnesota

• Allina Health
• HealthEast St. John’s
• HealthPartners

Mississippi

• Baptist Memorial Health Care

Montana

• Mercy Health
• Saint Luke’s Health System
• Spectrum Health

New Jersey

• Cooper University Hospital
• Hackensack Meridian Health
• Holy Name Medical Center
• Inspira Health
• Virtua Health

New Mexico

• Presbyterian Health Services

New York

• Beth Israel Deaconess – Lahey Health
• Catholic Health Services of Long Island
• Mary Imogene Bassett Hospital
• Mount Sinai
• Northwell Health
• NYU Langone Hospitals
• Rochester Regional Health
• State University of New York
• Strong Memorial Hospital
• United Health Services Hospitals

North Carolina

• Atrium Health
• Cone Health
• Duke Health
• Novant Health
• Scotland Memorial Hospital
• UNC Health
• WakeMed

North Dakota

• Essentia Health Fargo Hospital

Ohio

• Cleveland Clinic
• MetroHealth System
• Ohio State University Hospitals
• ProMedica
• University Hospitals Health System

Oklahoma

• INTEGRIS Health
• Mercy Health
• Norman Regional Hospital Authority
• Stillwater Medical Center Authority

Oregon

• Oregon Health and Science University
• Providence

Pennsylvania

• Allegheny Health Network
• Geisinger Health
• Penn State Health System
• Redeemer Health
• Wellspan Health System

Rhode Island

• Kent Hospital

South Carolina

• Medical University of South Carolina
• Prisma Health
• Roper St. Francis Healthcare

South Dakota

• Avera McKennan Hospital

Tennessee

• Ascension
• Ballad Health
• Baptist Memorial Health Care
• Covenant Health
• Methodist Healthcare – Memphis Hospital
• Vanderbilt University Medical Center
• University of Tennessee

Texas

• Baylor Scott and White Health
• Bexar County Hospital District (University Health)
• Harris Health System
• Medical City Healthcare
• Memorial Hermann Northeast
• North Texas Medical Center
• Parkland Hospital
• Resilient Health
• Texas Health System

Utah

• Intermountain Health System
• University of Utah Health and Huntsman Cancer Institute

Virginia

• Carilion Clinic
• Riverside Health System
• Sentara Norfolk General Hospital
• VCU Medical Center

Washington

• MultiCare
• Providence
• St. Joseph’s Medical Center
• Virginia Mason Franciscan Health

Wisconsin

• Bellin Memorial Hospital
• Gundersen Lutheran Medical Ct
• Marshfield Medical Center
• Mayo Clinic Northwest Wisconsin
• SSM Health
• University of Wisconsin (UW) Health

Source Links:

https://www.ummhealth.org/hospital-at-home
https://www.nature.com/articles/s41746-024-01040-9
https://www.johnshopkinssolutions.com/solution/hospital-at-home/
https://www.beckershospitalreview.com/telehealth/how-mass-general-brigham-built-the-largest-hospital-at-home.html?origin=BHRSUN&utm_source=BHRSUN&utm_medium=email&utm_content=newsletter&oly_enc_id=8220I2680390C6S
https://qualitynet.cms.gov/acute-hospital-care-at-home/resources
https://www.aha.org/aha-center-health-innovation-market-scan/2024-04-09-providers-betting-big-future-hospital-home
https://www.commonwealthfund.org/publications/newsletter-article/hospital-home-programs-improve-outcomes-lower-costs-face-resistance
https://nahc.org/nahc-hails-legislation-to-extend-hospital-at-home-waiver-program/