Mayo, Intermountain navigate 'Wild West' of starting Hospital at Home during COVID-19 pandemic

Home health senior nurse
Intermountain and Mayo Clinic explored how they have implemented Hospital at Home programs during a recent session from Fierce Healthcare's "Telehealth Takeover" event. (Image: KatarzynaBialasiewicz/Getty)

A global pandemic may not be the most ideal time to roll out a new initiative aimed at moving certain hospital services into the home.

But Mayo Clinic and Intermountain Healthcare shared that the implementation of their 'Hospital at Home' programs earlier this year has not been hurt too much by COVID-19 and could help the systems battle a new surge of the virus.

“The opportunity to discharge patients to home to create more beds for patients who might have COVID is a huge advantage,” said Jim Sheets, vice president of outreach for Intermountain.

Sheets and others spoke during a session entitled “Home is the New Hospital” during a Fierce Health IT's Virtual Series Telehealth Takeover event on Tuesday.

WATCH ON DEMAND: View Fierce Health IT's 'Home is the new Hospital'

Hospital at Home is a program gaining popularity among systems that deploys hospital-level care for a patient at their home. The patient can get acute inpatient care and a doctor will oversee that care from the patient’s home rather than the hospital facility.

The programs haven’t just helped preserve capacity to treat COVID-19 patients. Sheets said that the pandemic has helped broaden the acceptance of telehealth and remote monitoring services.

“It has changed the culture,” he said. “The acceptance of visiting with somebody over a computer, over a screen, has greatly improved.”

However, there are some challenges with setting up this program, especially when it comes to regulations and reimbursement as a Hospital at Home program differs from traditional home healthcare that is heavily regulated.

“Hospital at home programs are essentially the wild west right now,” said Dr. Margaret Paulson, director of advanced care at home for Mayo Clinic. “At Mayo, we have done our best to make sure compliance wise we follow the regulations with brick and mortar settings to still leave room for the unique circumstances that come up in the home.”

Mayo launched its program in July and has treated 47 patients and Intermountain launched in the spring and seen about 100 patients.

Paulson said she would like to see a specific reimbursement code from the Centers for Medicare & Medicaid Services would help to “push our program and a lot of burgeoning programs across the country.”

Sheets added he would like to see some movement to make it easier for doctors to provide care across state lines.

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He said putting together interstate licensing would help ensure that physicians in other states can service rural areas in another state.

Interstate licensure has been an issue that some providers have pushed for during the COVID-19 pandemic as doctors have sought to travel to treat patients in COVID-19 hotspots.

Another key challenge has been incorporating patients still under Medicare fee-for-service.

“All the patients in our hospital at home program for intermountain it is either those that have select insurance, which is our own insurance product, or those with a Medicare Advantage plan that we have a contract for,” Sheets said. “We pay for the service and bank on the downstream savings that we will see.”