The history of the hospital dates back to ancient antiquity. The earliest hospitals were located in Greek temples, called asclepieia. The physician-priests who worked there provided specialized services that could not be provided in the average Greek home.
In the 20th century, the asclepieion evolved into the modern hospital, and the care provided there, of course, evolved into modern medicine. Today, hospitals employ the concept of “hospital-level of care” to describe those elements of treatment that could not be provided in any setting other than a hospital. Since the early part of the century just ended, one important hospital-level of care was the need for intravenous (IV) fluids and medications, known broadly as infusion therapies. But the development of specialized nursing and allied technologies is rapidly moving infusion therapy from the hospital to the home.
Why Move Infusion Therapy to the Home?
Some patients are too ill to eat and require IV therapy to stay hydrated. However, many patients are otherwise well enough to be at home, but need IVs because the medications they are prescribed can be taken only by this route. In other words, there is no other reason for them to be in the hospital. What if a small part of the hospital could come home to them?
Today, patients can be sent home from the hospital with durable IVs that can be placed in their arms that are designed to last days, or even for weeks. Nurses who are specially trained in the care and maintenance of these IV lines can visit the patient’s home daily, or in some cases more than once per day. Specialized equipment, with “smart pump technology” has been developed specifically for home use. Over the last two decades, several new specialty drugs have been developed, all of which must be administered IV.
At home, a patient receiving treatment can enjoy the comfort of wearing his own clothes, sleeping in his own bed and eating food from his own kitchen. The reduced stress and improved feeling of well-being the patient feels contributes powerfully to the healing process.
The 21st Century Cures Act
The idea of receiving hospital level of care at home is attractive, but the service is expensive. Who is going to pay for it? Part D of Medicare reimburses patients for the costs of most medications that can be infused at home, but it does not pay for the skilled nurses or for the equipment involved.
In late 2016, both houses of Congress passed the 21st Century Cures Act, a major piece of legislation that, among other things, calls for Medicare reimbursement for nursing, pumps and tubing that make home infusion therapy possible. The Act is now awaiting passage of appropriation bills that are currently being drafted.
While partisan wrangling may slow the process in Washington, in the rest of the country, momentum is building toward home-based medical care. Evidence from medical literature suggests that home infusion therapy is safe, effective, and relatively cheap. Most important, patients prefer home therapy to hospital care. Clinical outcomes for patients treated at home are as good, or in some cases better than outcomes for patients treated in acute-care settings. The risk of developing infections related to care is much reduced at home compared with the hospital.
The Center Shifts
The center of gravity in the medical world has seesawed from the asclepieion in ancient Greece to the sufferer’s home in colonial America to the modern hospital by mid-20th century. Today, the center is beginning to shift away from the hospital and back to the patient’s home. The technology that makes the shift possible has already been developed. The skilled professionals trained to use that technology are ready to get to work. The science has demonstrated that home infusion is safe and effective. Political will is all that remains to make home infusion a reality.