When 90-year-old Doris Witt was taken to the hospital a few weeks ago because she was having trouble breathing, the elderly Warwick resident wasn’t sure when she’d be able to return home.
Doctors at Kent County Memorial Hospital told her the breathing problems were a sign of a mild worsening of her congestive heart failure, a condition in which the heart doesn’t pump blood well.
Witt was admitted to the hospital. But not for long.
Instead, she benefited from a 3-year-old program that allows certain patients to receive hospital-level care from the comfort of their homes, not in a hospital bed in a clinical setting.
Witt returned home several days sooner than a typical patient with congestive heart failure and, at the same time, she became the 1,000th person to participate in Kent’s Hospital at Home initiative.
Witt was just glad to be home after the brief hospital stay.
“I was so very surprised when I heard about it,” she said of the Hospital at Home program. “I just feel very safe and happy with the whole thing.”
Kent is one of a growing number of hospitals nationwide that are offering “hospital at home” programs, a mix of in-person care, telehealth videoconferencing and remote monitoring. The programs are believed by many to have a wide range of benefits, from improved patient comfort and lowered risk of infections to better health outcomes and cost savings.
In April 2021, 116 hospitals in 29 states were approved for a waiver by the U.S. Centers for Medicare and Medicaid Services – or CMS – to offer a hospital-at-home program for Medicare patients. Nearly four years later, that number stands at 388 hospitals in 39 states.
The Miriam Hospital and Rhode Island Hospital, both operated by Brown University Health, have also been approved for hospital-at-home programs and are “actively exploring next steps” in the process of developing them, Brown Health said.
Amid the increased adoption, however, there have been some reservations from health care professionals nationwide about the challenges of providing hospital-level care at home.
National Nurses United, the country’s largest union of registered nurses, has raised concerns.
In a 2022 report, the union said it’s dangerous to move patients away from trained medical professionals who are able to respond quickly. In a hospital, the CMS requires patients in an emergency to be treated immediately. For those being treated at home, the union said, CMS requires an emergency response within 30 minutes, after which a patient may still be taken to a hospital, causing more delays in lifesaving care.
The union did not respond to a request for comment.
A more immediate problem as of mid-March: The CMS waiver, enabled by federal legislation, was set to expire on March 31, unless the Senate passed legislation extending it through Sept. 25. The waiver has been extended twice since the program first launched in 2020 as a response to the COVID-19 pandemic.
Without the waiver, Medicare only covers care provided in a hospital.
Dr. Tyler Weisberger, who works full time for Kent’s Hospital at Home program, says hospital-at-home programs increase the availability of beds as hospitals continue to struggle with overcrowding and patients waiting longer to receive care.
Kent’s program usually has eight to 10 patients enrolled at a time.
“We are able to help decompress the hospital,” Weisberger said.
While Kent’s program offers care to Medicare patients under the CMS waiver, commercially insured and Medicaid patients are covered through an agreement with Rhode Island regulators and commercial insurers, said Raina Smith, spokesperson for Kent owner Care New England Health System.
Hospital-at-home programs can provide IV antibiotics and infusions, blood pressure monitoring, X-rays, respiratory and oxygen treatments, and electrocardiograms within a patient’s home.
In Witt’s case, doctors and hospital staff are administering daily respiratory and oxygen treatments, among other things, and monitoring her vital signs continuously through a remote device.
The program has earned support from the American Medical Association and American Hospital Association, which say it saves money and improves patient outcomes. Studies have shown that hospital readmission rates for hospital-at-home patients were about a third of the readmission rates for patients who stayed in the hospital.
Enrollment in the program is voluntary, and hospitals must follow CMS rules for patients on Medicare, including being able to respond to a patient emergency within 30 minutes; at least two in-person visits with a patient each day and one daily clinician visit, which can be remote; and a remote audio connection between a patient and the hospital-at-home team.
Locally, the Hospital Association of Rhode Island has expressed support for Kent’s program.
“As hospitals in Rhode Island continue to face challenges due to the state’s ongoing health care crisis, initiatives like Kent’s hospital-at-home program can be crucial in freeing up inpatient beds, lowering costs and improving patient outcomes,” Lisa Tomasso, HARI senior vice president, said in a statement to Providence Business News.
