Healing at home is a trend that’s been quickly gaining speed in developed countries around the world. In the United States, however, health systems that encourage patients who don’t need intensive 24/7 hospital care to opt for home care instead, is being adopted at a slower pace.
Why is the U.S. not leading the way?
According to a National Public Radio (NPR) article titled Patients Like Hospital Care At Home, But Some Insurers Are Skeptical published earlier this year, the key obstacle is getting health insurers in the U.S. to cover the costs for these services. While there are early adopters who are experimenting and seeing success to home hospital care and telehealth capabilities, there are still many barriers to wide-spread use.
While more common in countries such as Australia, England and Canada, health insurers in the U.S. are still figuring out how to adapt their payment models to reimburse hospital-at-home programs.
It wasn’t until recently that The Centers for Medicare & Medicaid Services (CMS) approved the use of virtual care codes that cover certain telehealth services. The adoption of these codes to cover services, such as virtual check-ins (HCPCS code GVCI1) and remote evaluation of pre-recorded patient information (HCPCS GRASS1), that don’t occur in face-to-face patient interactions allows patients to remain at home while receiving treatment that in the past would have required a more expensive hospital stay. Successful lobbying efforts by the AMA has generated CMS support that began in 2018. CMS is currently supporting clinicians who leverage remote monitoring tools, such as wearables and smart devices at home, and use patient-generated health data in care coordination and management.
But there’s still much to be done so that payers incentivize and reimburse providers for home-based hospital care.
A study recently published in the Journal of General Internal Medicine titled Hospital-Level Care at Home for Acutely Ill Adults, set out to determine if “home hospital care reduces cost while maintaining quality, safety, and patient experience.” Recognizing a need for scientific evidence based on trials conducted in the U.S., researchers compared healthcare use, experience and cost in patients who received hospital-level care at home with patients who received their care in the hospital. The 20 patients included in the trial received treatment in 2016 at Boston’s Brigham and Women’s Hospital for conditions such as infections, heart failure, chronic obstructive pulmonary disease (COPD) and asthma.
The study found that, while there were no adverse events reported among the patients who received home hospital care, their treatment costs were about half that of those receiving the same care at the hospital. Researchers also found that, while the patient experience was similar in both groups, home patients:
- Had fewer laboratory orders;
- Received consultations less often;
- Were more physically active;
- Showed a trend toward more sleep; and,
- Had fewer readmissions.
Given these positive outcomes, both on patient care and cost savings, and that of other published research and case studies, it is clear that home hospital care is a path to pursue for payers and providers.
As with the ultimate success of e-prescribing, the future of patients’ ability to heal at home rests in the hands of multiple players – industry organizations, government regulators, payers, providers, and patients. Working together we can advance the technology, integrate the data needed for seamless coordinated care, and make it accessible to the masses. We are seeing pockets of that happening today, but we need to continue to prove the value of home care so that it becomes the standard practice of care.
The future and stability of our healthcare system depends on it.