Charlotte, N.C.-based Advocate Health has roughly doubled its hospital-at-home capacity in the past year.
Here are nine things to know, according to a Becker's interview with program lead Dan Davis, MD:
1. Advocate Health has an average daily hospital-at-home census in the mid-70s, with the ability to treat 80 patients at a time and plans to expand that capacity to 100 by the end of 2024. The program's census was in the 40s at this time last year.
2. Advocate Health partners on hospital at home with Best Buy Health, whose Geek Squad sets up the remote patient monitoring technology such as wearable smart devices and a tablet for virtual visits with a physician.
3. The program is centered in the health system's Atrium Health market in Charlotte, N.C., and is available to patients who present to the emergency room or have been admitted at 10 Atrium hospitals located within 100 miles of Charlotte. About half the patients live in rural ZIP codes. Advocate Health intends to grow the care model to its Winston-Salem, N.C., market and Illinois.
4. The initiative has expanded from treating common conditions such as heart failure, COPD and cellulitis to oncology and post-operative patients, including after bariatric surgery.
5. The payer mix for the program is on par with Atrium's brick-and-mortar facilities, with about 60% Medicare and Medicare Advantage, roughly 10% North Carolina state Medicaid and the rest commercial insurance.
6. Under Advocate's hospital-at-home program, paramedics provide the twice-daily in-person visits required by CMS. North Carolina scope-of-practice laws enable paramedics to provide acute hospital care at home. Some states only allow registered nurses to perform the at-home visits.
7. Patient experience scores for the program have been high. Nearly 94% of hospital-at-home patients say they would recommend the care model, about 20 points higher than patients in brick-and-mortar facilities. Other benefits have included reduced readmissions and occupancy at participating hospitals.
8. The biggest challenge to scaling has been "logistics," Dr. Davis said. "So being able to locate your mobile integrated health, your community paramedics in places that are closer to where they're going to be serving patients; growing the pharmacy support in a way that minimizes the couriering of things."
9. The ultimate goal is to grow the program to 20% of inpatient bed capacity in the market, or 400 hospital-at-home "beds."