More than 300 hospitals have started hospital-at-home programs, but critics question how effective they are, The Wall Street Journal reported Aug. 13.
At-home care began as a nationwide experiment during the pandemic when hospitals were overcrowded. Regulators allowed hospitals to temporarily care for Medicare patients at home who are stable enough to be home but sick enough to need hospital-level care, and still charge hospital-stay rates. The idea stuck after the pandemic ended and hospital finances rebounded, and the programs have attracted a range of healthcare organizations and technology companies.
Despite growing popularity for the program among patients and hospitals, critics worry home-based services raise spending unnecessarily and reduce patient quality and safety.
Patients who receive at-home care see a staff member twice a day for prescriptions, blood draws and to provide and monitor equipment that captures patients' vital signs and movement. Hospitals must meet a number of requirements to provide at-home care, including being able to reach patients in 30 minutes, send patients to the hospital if there are concerns, and report unexpected deaths and the percentage of patients who return to hospitals. But beyond that, the requirements for at-home treatments are broad, allowing hospitals leeway to decide how to set up their programs, the report said.
More hospitals have relied on remote monitoring of patients rather than sending staff members, which some worry could affect quality of care. There is no standard for the technology, and hospitals argue that caring for patients at home creates logistical challenges for sending staff in person as well as sending equipment and medications.
Although hospitals have to report some measures of patient care, such as unexpected deaths, there is no requirement for falls, infections and how frequently patients end up hospitalized twice within 30 days — all measures that hospitals have to report. Hospitals also do not report on how easily patients can reach medical staff when needed, according to the Journal.
Some critics are concerned that Medicare at-home patients were treated for about one day longer than those in hospitals. Longer stays mean higher costs, which could give hospitals an incentive to overuse the service. Patients at home also have fewer expensive labs and radiology services, federal data found.
However, some systems push back on the concerns. Somerville, Mass.-based Mass General Brigham, which employs 250 staff members in its at-home program, said the system loses money on at-home patients. Driving between patients is less efficient than moving between beds, and medical staff in the program require higher training and higher wages.
In the long run, at-home care may be more profitable for hospitals. And some patients prefer to receive treatment in the comfort of their homes.
Overall, hospitals told the Journal that home-based medical care is safe and more comfortable for patients, adding that such programs open beds for patients with higher needs. However, Medicare will stop paying for at-home care after December unless Congress votes to continue the program.