SEATTLE – Home health care will increasingly replace hospital care, panelists said during a discussion of the phenomenon at the Swedish Medical Center symposium on "Innovations in the Age of Reform."
They weren’t just talking about lower-intensity care, either.
Consider the work of panelist Dr. Bruce Leff and his colleagues at Johns Hopkins University in Baltimore, who are among those developing – and disseminating – the "Hospital at Home" care model.
It’s about "true acute care," he said, "taking someone from the emergency department [where a] physician has said ‘this person needs to be admitted’ "for pneumonia, heart failure, chronic obstructive pulmonary disease, cellulitis, deep vein thrombosis, "and other things that people end up in the hospital for," and treating that person at home.
The "best way this works is when the ‘Hospital at Home’ is thought of as a virtual unit of the acute hospital. Recently, we’ve been partnering with proto-ACOs [accountable care organizations] that are very interested in this model," said Dr. Leff, a Hopkins geriatrician and professor of medicine.
Several things are driving the trend, he and other panelists said.
First, payers are looking to cut costs by cutting hospital admissions. Also, hospital executives want to empty their beds of patients on whom they lose money; patients generally prefer treatment at home; elderly patients usually do better there; and technology increasingly enables hospital-level home care, panelists said.
Hospitals are already being built with fewer beds than they might have had a decade ago. A $1 billion high-tech tower being built at Johns Hopkins won’t add any more beds to the campus, Dr. Leff noted.
Given the trend, if hospitals aren’t thinking about how to focus on high-margin patients and effectively treat others in lower-cost settings, "they’re dead; they’re gone," he said.
The trend toward home care has been embraced by one of the nation’s largest health care companies, Louisville, Ky.–based Kindred Healthcare Inc., according to CEO Paul Diaz, also a panelist. "We are increasingly investing in home care because 40% of our discharges are going to home care" already. "That’s where we see an opportunity for our patients and our shareholders," he said.
He and others said they think technology will further the trend.
Diane Cook, Ph.D., a professor of electrical engineering who was also a panelist, gave an example of what could be coming soon. She and her colleagues at Washington State University, Pullman, have rigged an apartment on campus with sensors (motion detectors, for instance, and stove-burner monitors) to see if the feedback accurately indicates how well patients – especially the elderly – perform day-to-day tasks, and if they need intervention.
If the technology proves itself, it could reduce unnecessary home-health visits, saving providers time and money.
Dr. Cook and her colleagues ultimately envision "a lightweight, simple package caregivers can purchase from Home Depot or Lowe’s" that would be capable of remote, hospital-level monitoring. The idea is to empower patients to "do as much as they can at home and avoid leaving their personal space to get care," she said.
Meanwhile, Dr. Leff and his colleagues are planning to pilot an adhesive strip–like sensor that could be used in the home. It "gives you everything you get in the ICU now, with 14 different probes and needles," he said.
"Hospital at Home" is already "a pretty intense intervention" that can include IV medications; oxygen and respiratory therapy; and x-rays, ultrasounds, and diagnostic labs, among other things, Dr. Leff said.
Patients can live alone, and nursing assistants ("a relatively cheap" addition) can help with daily activities if needed, he said.
About 90% of patients opt for home treatment if it is offered; the elderly in particular do better at home, with lower rates of delirium and functional decline and higher rates of care satisfaction, Dr. Leff said.
"I think we are [still] going to need hospitals. Intensive care is critical. Many people would like to deliver their babies in the hospital. A hospital [will be] where you will go for brief, ultraspecialized, high-tech care," he said.
"But I do think a lot of the other stuff is going to move out," Dr. Leff said.
Dr. Leff said he has no personal conflicts of interest. His research is supported in part by fees paid to Johns Hopkins for his consulting services. Dr. Cook said she did not currently have any disclosures.