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November 27, 2011

Idea That Might Work: “Hospital at Home” Model Delivers Hospital-Level Care

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Far too often, ideas developed by academics end up sitting in a dusty file or published by an insider journal that hospitals CEOs seldom see. In the following case, however, it seems academia and the hospital biz are seeing eye to eye on a new approach to acute care which could offer substantial savings.

A growing number of hospitals have begun to embrace the “Hospital at Home” model, an approach originally developed by the Johns Hopkins School of Medicine which offers hospital care to people in their own homes. HAH is focused on the elderly, not surprisingly given the high cost of caring for them, but I bet it’d offer advantages in caring for chronically-ill patients of just about any age.

While this approach isn’t as whiz-bang neat as, say, bringing an emergency department to a patient’s home — something already done in France — it’s a solid concept.

This model fits hand in glove with maturing technologies which monitor patients from afar while leaving in their home (tracking metrics like blood sugar, patient weight or cardiac functioning and shunting the data to doctors via the Internet).

According to a recent Forbes article, one of the biggest proponents of this approach is Presbyterian Healthcare Services, a New Mexico-based system which manages the largest program in the country. PHS has estimated that treatment averages one-third shorter than equivalent cases treated in an inpatient setting. And the system calculates that it’s saved $2,000 to $3,000 per case, as well. Neat stuff.

Folks, frankly I’m mystified that this approach hasn’t become more standard…or would be, I suppose, if the hospital industry I know and love didn’t have this habit of ignoring trends until they explode in someone’s face.

In any event, if any of you are implementing or even considering HAH, I’d love to hear from you. And if you think that this model can’t work, I’d love hearing from you even more. Let me have it!

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    2 responses to "Idea That Might Work: “Hospital at Home” Model Delivers Hospital-Level Care"

    1. # Stephen C. Acosta, MD commented on January 17th, 2012:

      The Hospital at Home concept actually started in France in the 1950s as a way to move people out of cancer wards and develped into a world-wide phenomenon over the decades. The Portland (OR) VA has had a ‘Program at Home’ housecall service since 2002 (and I am the current medical provider of services).

      The concept works, it saves money and people stay in their homes. But it still faces oposition, well known to the Johns Hopkins group and Bruce Leff, MD, the director, since the model only makes good economic sense in an HMO/managed care environment. The big drivers of medical costs, non-HMO hospitals, earn their money by providing services, materials and space, not by avoiding admissions.

    2. # Anne Zieger commented on January 25th, 2012:

      Dr. Acosta:

      Many thanks for your input on this issue — it’s most interesting.

      Sadly, you’re right that hospitals don’t make money on care they don’t provide. So getting telehealth and/or programs like this rolling depends heavily on some form of bundled payment across various providers which gives an incentive for providing care in the cheapest and most effective setting. My apologies if I don’t think the ACO model is quite “there” yet, maturity wise.

      Do you find that people like seeing you at home? I’m betting they’re thrilled.

      -Anne

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