My father told the story that the day he was born workmen were at the house to apply stucco to the exterior. That’s only noteworthy because my father was born at home. The country doctor came to the house to deliver him. Back in the day doctors made house calls. Medical science was not nearly as advanced as it is today. The AMA Journal of Ethics explains the situation:
One hundred years ago… Physicians practiced and treated patients in their homes. The few hospitals that existed provided minimal therapeutic care.Medical science and technology were primitive, and there was little that physicians could do to treat most illnesses.
With the advent of modern medicine, hospitals and clinics became filled with equipment. As modern medicine became more advanced and industrialized, patients began to que at clinics to see a doctor, and more serious illness was treated in hospitals.
Some public health advocates think back and view house calls as a simpler, more caring time in the history of medicine. The reality is that house calls are an inefficient use of physician’s time, but I digress. With telemedicine, Zoom video-style technology and remote monitoring doctors do not always have to see their patients in person. Or, put another way, the patient doesn’t always have to trek to the doctor’s office, or even the hospital. The Wall Street Journal reports that some Medicare patients are admitted to the hospital but treated in their own homes, in their own beds.
Around the country, more than 300 hospitals are deploying or preparing to dispatch paramedics, nurse practitioners and other medical staff to treat patients at home instead of in hospital settings, a service widely referred to as hospital at home.
During the pandemic hospitals were full of covid patients, there were no empty beds. It was not safe to treat other patients alongside those who were contagious with covid. The Centers for Medicare and Medicaid Services proposed a fix: Medicare patients could be hospitalized in their own homes and the hospitals coordinating their care would receive the same payment as though patients were in the hospital.
But policymakers say they fear hospitals are overpaid and will overuse the home-based services, raising spending unnecessarily. As more health systems adopt these models, clinicians and regulators also grow concerned about the quality and safety of these programs. Patients, too, question the risks they face.
Hospital at home sounds like a good idea for many patients. However, there is the potential for misuse or abuse:
Not everyone is eligible for these programs. Hospitals limit their selection to patients who are stable enough to be at home, but sick enough to need hospital-level care.Patients who are eligible for these programs receive home visits twice a day from staff who deliver prescriptions, draw blood and outfit homes with equipment to remotely monitor patients’ vital signs and movement.
I used to work in a facility that treated patients similar to these: patients who were very sick but medically stable. However, the hospital was paid far less than regular rates for this type of care. Furthermore, providing care in the home is not an easy task:
Caring for patients at home also creates logistical challenges for hospitals that create potential risks, said Dr. Sachin Jain…In addition to sending medical workers out, hospitals must coordinate drop-offs of medications, monitoring and medical devices, laboratory work and other essentials, such as food. Gaps and delays could be harmful, he said.
Medicare patients hospitalized at home have longer stays compared to similar inpatients, by about one day. That boosts costs. Patients too are probably less likely to badger doctors to discharge them since they’re already home. Driving to patient’s homes is also less efficient for care providers than moving from room to room with each successive patient.
From a policy standpoint hospital at home raises questions. Why should hospitals get paid the same amount for treating patients in their own home compared to treating patients at a billion-dollar hospital campus? But, then again, if labor is a major cost for hospitals, why wouldn’t it be cheaper to treat patients in the hospital? Hospital at home is novel idea, but it’s far from disruptive if the same providers get paid the same amounts regardless of where care is delivered.
Read more at: Hospitals’ New Push: Treating Patients in Their Homes