Despite uncertainties over reimbursement, Mass General Brigham is "all in" on hospital-at-home care, a program leader told Becker's.
The Somerville, Mass.-based health system has one of the oldest — and largest — acute-care-at-home programs in the country. It started in 2016 and will expand to 50 beds in late March, with a current average daily census of 35 patients.
Some health systems, however, have been apprehensive about diving into the care model since the CMS reimbursement waiver expires at the end of 2024.
"We're all in," Stephen Dorner, MD, chief clinical and innovation officer of Mass General Brigham Healthcare at Home, told Becker's. "We're committed that this is the best way for us to deliver care and will advocate and continue to support ways that make it possible. I think it's how patients want care too."
Mass General Brigham plans to roll out additional hospital-at-home care pathways soon, treating post-operative, oncology and postpartum patients. While the program's eventual goal is to reach 10% of inpatient capacity, or upward of 200 beds, it will likely top out at around 60 or 70 beds by the end of 2024.
Mass General Brigham went live with hospital-at-home technology from Best Buy Health in February. The health system uses the retailer's Current Health remote patient monitoring platform and Lively fall detection and emergency response system.
"The Current Health remote monitoring solution has really great reliability of connectivity," Dr. Dorner said. "It has a safeguard that uses cellular technology and oscillates between the three biggest national cellular carriers and finds whichever among those three has the strongest signal in the home and then turns that into a local Wi-Fi network for their devices to connect."
The health system is also looking to the future of at-home technology, he said. That could include things like a remote companion, a voice assistant that can converse with patients via generative artificial intelligence.
"If you think about how AI is implemented to detect findings on X-rays or findings on CT scans, for example, imagine you could do the same thing within cardiac rhythm strips, where you've got predictive algorithms that are looking at telemetry and finding when there's an arrhythmia that's been developed instead of having an individual monitoring that rhythm strip 24 hours a day," Dr. Dorner explained.
Best Buy Health technology, he noted, has been able to successfully remotely monitor cancer patients at Nashville, Tenn.-based HCA Healthcare after they received CAR-T cell therapy, alerting clinicians if they're having issues and avoiding hospital stays.
That doesn't mean technology will substitute for human-based healthcare, he said. Rather, he called "hospital at home" a tech-enabled care model, allowing patients to heal in their preferred environment while still being treated by human clinicians.
Beyond the fact that many patients would prefer to be cared for at home, "hospital at home" is a necessity for the American healthcare system moving forward, Dr. Dorner said.
"We are not going to be able to build hospitals fast enough, much less afford them, for the growing rate of demand as the baby boomer population ages," he said. "As you look at the figures, it's north of $1 million to $2 million for hospital beds to create within a brick-and-mortar environment that then you have to maintain. It's a fraction of that to deliver care within the home-based space. I think it's the only sustainable solution for us as the need for care grows."
"We're always going to need hospitals for emergency rooms, for ORs, for ICUs," he added. "But I think a lot of what we do in hospitals today, in the not-too-distant future, will be transferable to the home-based space. It's just about: How do we best support the patient's home environment to make it capable of supporting that? And that's where things like digital connectivity, remote monitoring capabilities — all that comes into play."
Dr. Dorner said he believes the care model will really take off if and when the federal government makes CMS reimbursement indefinite. He said some of his peers predict that "hospital at home" will grow tenfold in the next five years, reaching 15% of inpatient capacity.
"Even now, while there is so much uncertainty still, there's so much interest, so much innovation happening, that I think people are ready to jump at the notice that, 'Yes, this is a permanent way we're going to deliver care,' and we're just going to see it start to rapidly evolve from there," he said.