As Covid-19 spread across the United States during 2020 and a large volume of cases burdened hospitals to address the capacity demands, the U.S. Centers for Medicare & Medicaid Services (CMS) responded by providing several new flexibilities and waivers to ensure that acute hospital care can be appropriately provided to selected patients with inpatient-level care in their homes. This is an important step during a public health emergency (PHE) to care for patients at home and improve healthcare outcomes despite challenges for reimbursement under this model.
Hospitals are required to provide inpatient services for the patients at home that include transportation, food, DMEs, pharmacy, diagnostic (labs and radiology), social work and care coordination, and PT, OT, and ST services.
Hospital-at-Home allows patients to remain in the comfort of their own home while still receiving the same hospital-level care post-discharge after meeting certain inclusion/exclusion criteria to be eligible. The hospital-at-home care model avoids common complications associated with stays in the traditional hospital setting. So, how does a hospital at home work? What leads up to it and what happens afterward? Here we explore the basic steps of each phase of the Hospital-at-Home Model.
Before Hospital-at-Home
Hospital-at-Home has not only proven to be a clinically successful model for hospitals, but it has also increased patient satisfaction and reduced readmissions and ED visits.
Step one
A patient in need of hospital care is identified by either the emergency department/in-patients services who will be qualified by a Hospital-at-Home physician. Clearly defined criteria determine whether a patient is eligible and certain conditions that are considered to be treatable at home are an important determinant.
Step two
If the patient is eligible the physician describes what the next steps would be. They are then asked to consent to be treated by the hospital-at-home program. If they consent a confirmation is usually made that the home has air conditioning, heat, running water, etc. upon completion of assessments.
Step three
The patient is assigned a physician. After the physician creates a Plan of Care, a care coordinator meets the patient to discuss the next steps, arrange transportation, as well as arrange for any needed equipment to be sent to the home. Equipment can arrive before, with, or after the patient. Equipment may come with someone to set things up and explain how they work.
During Hospital-at-Home
Step four
At home, the patient receives care according to their personalized care plan. Extended care continues after release from the hospital. Other orders may also be carried out by other clinical team members such as physical therapists, occupational therapists, nurses, or EMTs doing things such as IV medication or fluids, nebulizer treatments, EKG’s and other tests or treatments.
Step five
The care team must be available 24/7 for any emergency that may arise. Many hospital-at-home setups come with an emergency preparedness plan and kit should an emergency arise.
Step six
Whether at home or via telehealth, the physician visits the patient daily, monitoring the situation. The team continues to implement care and make updates according to the physician’s notes, the plan of care, and the progress or lack thereof that the patient is making.
Step seven
For any tests or treatments that can’t be performed at home, the patient is briefly transported back to the hospital or necessary medical facilities for short visits as needed.
Step eight
Once the patient has reached an improved objective or has achieved stabilization they are released from the hospital at home program and returned to the care of their primary care physician. This is most often when they can return to their daily activities without taking a step back in their health journey.
After Hospital-At-Home
It is vital to be vigilant to ensure that hospital staff is ready to respond to CMS acute care at home program changes for the acutely ill patients receiving at-home care. It is imperative that hospital teams provide safe, high-quality, and reliable care in the home that is consistent with the standard of care that is provided in a hospital setting.
Step nine
The patient continues to check in as needed with their primary care physician, has virtual visits, or is put under the monitored at home program depending on their healthcare needs post-discharge from the HAH program.
- Hospital-at-Home patients overall have lower rates of mortality, less medication use
- There is an overall higher satisfaction of patients and their families
- Significant cost savings compared to traditional hospitalization
How Rainbow Health’s platform can support some of the requirements below for your Hospital-at-Home Program via a single platform.
- Inclusion/Exclusion criteria and patient consent for HAH enrollment.
- One daily Provider visit, either remote after the initial in-person visit performed in the hospital or the ED. At Least 2 home visits by an RN or Paramedic team member.
- Additional RN remote visits may be needed.
- Emergency in-home visit to a patient's home in 30 mins, if needed.
- In-home services and better care coordination.
- Establish a local safety committee for reviewing metrics before submitted to CMS.
Integrated telemedicine and in-person visits dispatch solutions to support home appointments with a bird's eye map view for real-time status. Necessary assessments, supporting documentation, and order/referral management for in-home services support that leads to better care coordination. In addition, a plug-and-play dashboard with important metrics such as escalation rate, new patient admissions to the home setting, patient escalations of care from the home to the hospital, daily census, mortality and graduation rate, etc.
Conclusion
Understanding the steps to navigate healthcare at home can help lower frustration. Overall, hospital-at-home has seen to have quicker recovery, lower re-hospitalization rates, cost savings, and better patient satisfaction. This makes it one of the best choices for those who can make the decision between staying in the hospital or choosing a hospital-at-home program. Rainbow Health looks forward to partnering with CMS Hospital-at-Home participants to further combat COVID-19 and advance the at-home care delivery models that are focused on delivering safe, effective, high-quality care in the preferred setting of patients-Home.
A Sustainable care-at-home program requires a comprehensive end-to-end solution designed to move the needle on for better patient outcomes and your organization's bottom line. To help you navigate the challenges of launching a new program as well as operationalize and scale your existing program, Rainbow Health can provide the right technology and services as your trusted partner.
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