To truly scale "hospital at home," its leaders should take a page from hospitalists, a similarly disruptive care model that grew exponentially, two physician leaders wrote in Health Affairs.
Hospital-at-home physicians also need a catchy name, a la hospitalists, the authors said in the March 26 article. How about "home hospitalists"?
"Like hospitalists, HaH providers must define the specific clinical and operational competencies of a home-based site-defined generalist specialist," wrote Robert Zimbroff, MD, associate medical director of San Francisco-based UCSF Health's Care at Home program, and Robert Wachter, MD, professor and chair of the department of medicine at the University of California, San Francisco. "They would be helped by naming their physician workforce and buttressing the arguments for this being a new specialty."
Hospital-at-home programs can also be expensive to set up, with command centers costing upward of $5 million and an extensive supply chain network required, while continued reimbursement from CMS is uncertain, the authors noted. So leaders also need to show the business value to their health systems' executive teams.
"In making their business case, hospitalists convinced hospital and healthcare executives that it would be more expensive not to implement hospital medicine programs than to build and support them," Drs. Zimbroff and Wachter wrote. "For HaH to thrive, it must do the same."
For example, they said, program leaders could explain how home-based care could free up hospital beds for "higher-acuity patients reimbursed at higher rates," with the increased revenue from the "bed arbitrage" being invested back into "hospital at home."