Intensive care at home can cut costs, increase patient satisfaction

nurse with patient in a wheelchair

Intensive home health care, an alternative to hospital admission, offers the potential to ease bed-capacity problems, cut costs and improve patient satisfaction, according to a perspective article published in The New England Journal of Medicine.

It’s an idea being used in countries such as the United Kingdom, France, New Zealand, and Australia, write authors Luis Ticona, a health policy and management fellow at Massachusetts General Hospital, and Kevin Schulman, a professor of medicine in the Duke University School of Medicine. Multidisciplinary teams provide acute-level care in patients’ homes after they’re evaluated and diagnosed in the emergency department or after a brief hospitalization. With physician oversight, nurses provide customized comprehensive services, such as home infusion, telehealth visits, on-site tests and pharmacy.

Patients experiencing exacerbations of heart failure or chronic obstructive pulmonary disease, stable pulmonary embolism or pneumonia make good candidates for at-home intensive care, according to the authors.

There are few such programs in the United States, though; notables include those at Presbyterian Healthcare at Home in Albuquerque, New Mexico; VA programs at 11 sites, and offerings from Cedars-Sinai Medical Center in Los Angeles and Kaiser Permanente in Riverside, California.

Developing effective eligibility criteria is an important challenge for such programs, the authors say, but lack of financial alignment has been a major barrier.

The Centers for Medicare & Medicaid Services proposed alternative payment models for programs such as these. It awarded an innovation grant to New York’s Icahn School of Medicine at Mount Sinai to test a “hospital at home” model that may be used to inform a bundled-payment approach to reimbursement.

Other health systems are using virtual care to monitor ICUs remotely or offer clinical visits remotely. In some hospitals, meanwhile, representatives of home health or visiting nurse agencies coordinate care between the ER and home.