Call it home sweet hospital.
Kent County Memorial Hospital in Warwick recently received a waiver from the U.S. Centers for Medicare and Medicaid Services and approval from the R.I. Department of Health to offer the state’s first hospital-at-home acute care program.
“I think it’s the future of health care in Rhode Island,” said Dr. Ana Tuya Fulton, executive chief of geriatrics and palliative care for Care New England Health System. Fulton has been overseeing the launch of the new program at Kent Hospital.
The state’s second-largest hospital is joining 186 other medical facilities in 34 states that have received such waivers, which allows for vital Medicare reimbursement at the same rate as in-person hospital care. Because of the COVID-19 crisis, the Centers for Medicare and Medicaid Services last year moved to allow full coverage for hospital-at-home care in the face of a rising number of hospitalizations.
While physicians have been making house calls for hundreds of years, hospital-at-home programs as they are currently known date back to the 1990s, pioneered by a geriatrician and professor of medicine named Dr. Bruce Leff at Johns Hopkins University. His research demonstrated the health benefits of keeping a patient in their familiar comfort zone. Among them: fewer falls, drastic reductions in delirium, decreases in infections and better food.
Kent will join at least three hospital systems in Massachusetts that have been pleased with the results of their hospital-at-home program, including Brigham & Women’s Hospital, Massachusetts General Hospital, both in Boston, and University of Massachusetts Memorial Health in Worcester.
“Patients like being in their home, where they’re happier and sleeping in their own beds, surrounded by loved ones, their favorite cat and TV,” said Dr. Taki Michaelidis, medical director of the program at UMass Memorial Health. “In your home environment, you just recover better.”
Hospital-at-home services are generally aimed at older adults who don’t need intensive care, Fulton said.
“We know older adults do better in familiar settings,” Fulton said. “Hospitalization can present complications for older adults. Hospital-at-home can be higher-quality care for older adults who have complications in the traditional hospital settings.”
Kent Hospital is launching the program in January after a soft launch in the last few weeks of 2021. The hospital is establishing a “command center” at the Trowbridge Building on the Kent campus, and the program is being staffed by an around-the-clock team of eight to 10 dedicated employees who will monitor a total of 10 patients, with the hospital equipping each patient with a computer tablet for telehealth services, in addition to equipment to monitor vital signs, Fulton said.
Kent’s hospital-at-home program, which requires an in-person physician evaluation before someone is admitted, also entails daily home visits from a registered nurse and mobile integrated health paramedics, and a daily check-in with a physician, which can take place virtually. If the condition of the patient suddenly declines, as detected from their vital signs or a report to the hospital, the command center sends a paramedic or doctor to the home as quickly as possible, Fulton said. If an emergency arises, doctors and paramedics can make it to the patient’s home within 30 minutes, based on the limited coverage area for the program, Fulton said.
Kent Hospital’s waiver lasts for one year, at which time the state Department of Health and the Medicare program could renew the program, Fulton said.
While such programs create more space at the hospital, they don’t solve staffing problems plaguing hospitals nationwide, Michaelidis said.
“What you do see at times is there are some efficiencies we gain,” he said. “Where those come from is that we can virtually monitor patients. … It’s safe, effective and frankly families love it.”
In addition to increasing a patient’s comfort and mobility, hospital-at-home programs help limit the spread of contagious diseases in the hospital environment, Michaelidis said.
At Brigham and Women’s Hospital, hospital-at-home services have predated the Medicare waiver by four years, now serving 16 at-home beds, said Dr. David Levine, who leads the program. Levine conducted a randomized control trial in 2018 that showed that median direct costs of acute care for hospital-at-home patients were 52% less than control patients receiving traditional care, and readmissions were 24% less.
A big difference is increased mobility, as patients in a hospital are less likely to walk around the room and hallways than a person in his or her own home, Levine said. Staying immobile can lead to more health problems, he said.
“It’s called hospital-acquired disability,” Levine said. “If you’re lying in bed for a day, that debilitates your body quickly, especially if you’re an older adult. Anything we can do to change that equation is very powerful for patient status.”
Marc Larocque is a PBN staff writer. Contact him at Larocque@PBN.com.
