As value trumps volume, some hospitals treat patients at home

While some hospitals use the old-fashioned concept of the house call to provide better post-discharge care, other organizations take the idea even further by treating certain patients entirely from the comfort of their homes, according to post on the New York Times' Well blog.

New York City's Mount Sinai Hospital is one such organization, as it allows patients like Martin Fernandez, an 82-year-old who lives on the Upper West Side, to receive treatment outside of a traditional hospital setting. For Fernandez, that meant doctors and nurses visited him at his daughter's nearby apartment to treat him for a urinary tract infection.

Mount Sinai's "mobile acute care program," which is funded by a nearly $10 million grant from the Centers for Medicare & Medicaid Services, is modeled after a concept that Bruce Leff, M.D., pioneered decades ago at the Johns Hopkins University School of Medicine. His Hospital at Home pilot program produced promising results of better outcomes and shorter "hospitalizations," according to his findings published in the Annals of Internal Medicine in 2005.

In a system driven by a fee-for-service payment model, though, many payers weren't eager to back such an initiative, and Medicare does not reimburse for hospital-level treatment at home, according to the Times. But as a value-based payment model takes hold in the industry and more providers offer their own health plans, the tide may be turning.

Rising awareness of patient harms, such as hospital-acquired infections, falls and other medical errors may also fuel the trend, according to the post. Indeed, because many of these adverse events are particularly dangerous for older patients, more have turned to nursing homes as their primary healthcare option.

Home-based healthcare has its limitations, however. It's difficult to judge which patients can safely be treated at home, and if patients' conditions worsen, they may need an emergency trip to the hospital after all. Still, the latter only occurs about 2.5 percent of the time in the Hospital at Home program run by Presbyterian Healthcare Services in Albuquerque, according to the post. For its part, Mount Sinai has asked emergency medical personnel to avoid taking its home-based patients to the hospital whenever possible as well as arranged to provide 24-hour clinical coverage for those patients.

If such an approach pays off, Leff predicts that an increasing number of providers will take notice. "My sense is that over time, hospitals will become places that you go only to get really specialized, really high-tech care," he told the Times.

To learn more:
- read the post