Kaiser Permanente has been among the more vocal champions of hospital-at-home programs over the last several months.
In May, the California system headlined a $100 million strategic investment into at-home acute care company Medically Home and, along with Mayo Clinic, announced it would be massively scaling up its early deployments of the startup’s services across its markets.
Just a few weeks back, the partners recruited nearly a dozen other health systems to launch the Advanced Care at Home Coalition. The advocacy group said it would be petitioning Capitol Hill to extend telehealth, remote and in-home care flexibilities enabled by the COVID-19 public health emergency.
Kaiser and other supporters of the shift to in-home acute care say the tech-enabled strategy can limit strain on hospitals, reduce costs and drive better outcomes among patients who are able to recover in the comfort of their own homes.
Thursday, however, Kaiser and its hospital-at-home strategy caught flak from a national nurses union that said it is “completely opposed” to what they see as a play to maximize revenue and limit the need for registered nurses during care delivery.
“Nurses are horrified by Kaiser’s attempts to redefine what constitutes a hospital and what counts as nursing care,” National Nurses United (NNU) wrote in a statement.
“Not only does this program endanger the imminent safety and lives of patients, it completely undermines the central role registered nurses play in the hands-on care that patients need to safely heal and recover. … We reject Kaiser’s assertion that iPads, cameras, monitors and the occasional visit by likely lesser-skilled and unlicensed personnel are in any way comparable to the skilled, expert nursing care and social-emotional support we [registered nurses] provide every moment of every shift,” the union wrote.
The hospital-at-home trend extends beyond Kaiser alone. According to NNU, at least 82 health systems running 186 hospitals across 33 states are currently allowed to operate and bill Medicare for at-home acute care arrangements.
Still, the union shined its spotlight on Kaiser, which it said is striving to be “at the forefront in normalizing” a delivery model they say will not achieve the positive outcomes its advocates are promising.
“Kaiser and the hospital industry will claim that these programs … have as-good-as-or-better outcomes than patients cared for in a regular hospital setting,” NNU wrote, “but we are skeptical of these small, selective, limited studies and suspect that these rosy outcomes are largely the result of cherry-picking the healthiest patients with the least complications and that such outcomes could not be maintained once these programs are scaled up to include high-acuity, complex cases.”
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NNU wrote that the primary driver for these programs is not to improve patient care or satisfaction but “the revelatory idea” that they will be able to shift hospital overhead costs onto the patient by sending them home.
“This model will prove to be a gold mine for Kaiser and the rest of the hospital industry as long as payers such as the Centers for Medicare and Medicaid Services reimburse them at the same rates that traditional hospital care commands,” NNU wrote.
Successfully lobbying to make COVID-19 telemedicine waivers permanent would provide “lucrative revenue” to hospitals, the union wrote, ultimately leading organizations to shutter inpatient services and limit their need for registered nurses.
“Brick-and-mortar rural hospitals, already an endangered species, will certainly go extinct,” NNU wrote.
In a statement provided to Fierce Healthcare, Kaiser said its Advanced Care at Home Program does not limit the role of hospital nurses, who “will continue to play a critically important and highly valued role at Kaiser Permanente.”
Further, the system stressed that its program does not compromise the quality of care being delivered by the organization.
“Regardless of whether the patients are receiving care in the comfort of their own home or in a hospital, we hold ourselves to the same high standard of care. The program empowers multidisciplinary care teams to provide the right care at the right time meeting our patients where they want to be," the health system said in its statement.
NNU contended that placing the burden of patient care on individuals or their family members has previously been shown to cause infections. Similarly, the hospital industry “already has the power to mitigate” hospital-acquired infections and similar preventable conditions without removing patients from the hospital altogether, the union wrote.
NNU also raised concerns that hospital-at-home programs could heighten racial disparities in care. Those with better housing, resources, family and social networks will likely fare better in these programs than the underserved, the group wrote, meaning any financial pressure to enroll patients in the lower-cost program could lead to worse outcomes.
Kaiser noted in its response that patients “must meet established clinical and safety criteria” to be enrolled in its current Advanced Care at Home program.
NNU closed out its condemnation statement with a plea to the public and to private and government payers not to support hospital-at-home programs and to instead “invest in the proven healthcare infrastructure and [registered nurse] workforce we know we need.”
Although Kaiser and its partners have claimed their fair share of hospital-at-home headlines, support for the programs has come from other sources as well.
Back in March, Amazon, Intermountain Healthcare and Ascension kicked off the Moving Health Home coalition that similarly looks to win policymakers over to the value of a “Hospital without Walls.”
Recent months have seen a flurry of partnership and acquisition deals focused on the space. Home recovery care services and technology company Contessa was purchased by Amedisys for $250 million over the summer and launched a new program with Henry Ford Health System about a month back.