Healthcare Moves Back Home

Wars, pandemics and natural disasters are what can safely be called “disruptors” and consequently- accelerators of change. The difference between incremental change and disruptive change is a matter of speed and magnitude. Prior to 1920, the focus of healthcare in the United States was the home. Most babies were born there, most people who got sick were treated there and sadly, most people died there. Doctors came only when someone called them- making what was known as “house calls”. People only went to hospitals when something really serious was happening to them or when they sustained a traumatic injury.

After WWII, the focus of care transitioned to doctors’ offices and hospitals. The care path was generally home to doctor, doctor’s office to hospital and hospital; to home.

By the early 21st Century, new wrinkles had entered the care path. Stand-alone hospitals morphed into “systems, replete with outpatient clinics and other locations away from the home to a point where virtually no care was rendered in the home.

The COVID-19 pandemic of 2020, coupled with the dynamic growth of the number of senior citizens (as of the 2020 census, 1 in six people in the U.S, were 65 or older, and the two most rapidly growing groups were 85 and older and 100 and older), brought clarity to the fact that perhaps it would be getting more and more difficult for many people to go outside their homes for care.

The pandemic forced care back to the home. Hospitals were overcrowded and most patients with less than life-threatening cases were forced to stay home, receive treatment via telehealth or ER visits, then returning home, because there was simply no place to put them. To address the needs brought about by the pandemic, The Centers for Medicare and Medicaid Services (CMS) removed former rules concerning health care at home and introduced the Acute Hospital Care At Home Program Waiver. This greatly lightened the load for hospitals.

Once the COVID crisis passed, many health systems saw an opportunity to extend care to an underserved population, while freeing up beds, reducing demands on hospital-based caregivers, reducing the incidence of hospital-acquired illnesses and creating a way to keep and re-energize staff who may have been burned out by the seriousness of the pandemic.

In a recent article in Becker’s Hospital Review, it was noted that as of February, 2024, CMS has authorized over 300 hospitals in 37 states to establish such programs. The major retardant to establishing such a program seems to be uncertainties regarding reimbursement for the services.

Two early adopters of the Acute Care at Home concept include the Cleveland Clinic (Florida) and OSF Healthcare in Peoria, Illinois. Both organizations determined that the concept of acute care at home was one worth evaluating. Early on, they devoted a great deal of time and effort to identify and address the issues, possibilities, challenges and needs associated with establishing such a program. Both saw the following potentially positive impacts of establishing such a program:

·?????? The ability to limit the need for building new inpatient facilities by freeing up beds in existing ones

·?????? The ability to repurpose the freed-up beds toward giving care to people with more serious diagnoses

·?????? The ability to refresh, recharge and retain employees who may have been on the verge of burnout following the COVID-19 pandemic

Taking acute care to the home requires an entirely different infrastructure and support system than that needed for a brick and mortar site. The Clinic employed its own staff to build the relationships and partnerships required, while OSF partnered with Medically Home to un-muddy the waters before they began operations.

To date, the results for both organizations have at least met, if not exceeded expectations. In an article in Becker’s (January 16, 20240), Drs. Conor Delaney and Richard Rothman of the Cleveland Clinic wrote:

Currently, our nursing and physician teams care for patients virtually from the command center where they can also interact with each other. It has been interesting that the intimacy of the nurse-patient interactions created real openness to remotely caring for patients within their homes. ? Today, our nurses and physicians… [TR1]?[FC2]?care for patients with complex medical illnesses and co-morbid conditions including exacerbations of acute chronic heart failure and those from underlying lung disease, pneumonia, diseases of the small and large intestine, and skin and soft tissues infections. ? Some of our most vulnerable patients with cancer already burdened by multiple medical facility visits and compromised immune systems from their treatment can now receive hospital level care within their home without the burden of additional facility stays.?

Likewise, Kelly Alexander of Medically Home stated that to date over 400 patients have been admitted to the program at OSF, with experiences similar to those experienced by Cleveland Clinic. One of the biggest aspects of the entire approach is the opportunity for people who are sick and frightened to be cared for by medical professionals, furnished with needed equipment, medicines and supplies and having access to the best physicians in the safety and comfort of familiar surroundings. Mitigating fear and apprehension is a multiplier for a speedy recovery, and that’s what happens when you are in your own home.

Call to Action. According to Tom Redding, St. Onge’s Senior Managing Director, Healthcare, “The Acute Care at Home model requires a different way of thinking and integrating support services.? Health systems have to shift their mindset to a service-oriented organization.? Logistics will be a key enabler for the delivery of care at home…if they don’t know how to be a service-minded organization then they will fail at delivering services at home.? Today, it is all about cutting costs…

Today: Support services are the areas where they are looking for savings.

Future: The delivery of support services will be focused on service excellence – if the goal is to cut costs then it may have a significant impact on their ability to delivery patient care.”

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Let us help. For over forty years, St. Onge has been helping organizations find solutions to complex problems like those faced when considering the prospect of implementing Acute Care at Home. The concept requires the development of a sophisticated, interlaced logistic system involving the movement of people, supplies, medicines and equipment. It brings with it the need to forecast demand and to plan for the types and number of specialty care equipment- beds, IV poles, patient lifters, etc.- things that are often taken for granted in the day-to-day of the brick and mortar hospital. Not only does an organization have to figure out what resources it needs to render the services, it also has to take into account the capacity of potential patients to provide the services necessary to support medical equipment in the home and telemedicine. It is not a simple process, but these are the types of challenges that must be addressed and surmounted prior to start-up.

So, if you are thinking about Acute Care at Home, CONTACT US. We stand ready to serve.

Fred Crans, Business Development Executive, Healthcare

[email protected]

563-503-1847

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