A model of care adopted in Australia, England, Israel, and Canada that allows patients who are chronically ill with acute medical problems to receive hospital services in their homes is gaining attention in the United States, says a Kaiser Health News article.
Hospital-at-home programs fundamentally refashion care by "testing traditional notions of how services should be delivered when people become seriously ill." In most programs, physicians examine the patient daily, and nurses and aides visit up to 3 times a day, often for an extended period. Programs currently are offered by Presbyterian Healthcare Services in Albuquerque, New Mexico, and through the Veterans Health Administration in Portland, Oregon; Honolulu; Boise, Idaho; and New Orleans.
In a study of 3 hospital-at-home programs published in 2005 in Annals of Internal Medicine, researchers demonstrated that patient outcomes were similar or better, satisfaction was higher, and costs were 32% less than traditional hospitalizations. The programs in the study focused on people with 4 conditions—chronic obstructive pulmonary disease, congestive heart failure, pneumonia, and cellulitis.
Resistance from Medicare and private insurers is the biggest problem these programs face, the article says. Traditional fee-for-service Medicare does not pay for hospital-at-home services, although individual private Medicare Advantage plans may do so.
In addition, physicians may find the new model of care intimidating. Starting a program requires a considerable up-front investment of time and money. Furthermore, "keeping beds full is a financial mandate for most hospitals." However, that may change as hospitals and physicians form accountable care organizations that call for providers to restructure how health care is delivered while participating in the financial rewards and risks of those changes, says the article.
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