Hospital At Home A Flawed Model

Blog#145- 1/29/23

HOSPITAL AT HOME
A FLAWED MODEL
ByRichard Davis

There has been a movement over the past few years to energize the concept of providing some degree of hospital level care at home. Medicare has been modifying its rules to pay for projects that move in this direction and some policymakers are touting this concept as a welcome addition to the health care system.

The Hospital at Home program is quite simply a bad idea. Why would we want to beef up the hospital system of care when it is clear that we should be putting the majority of our health care dollars into prevention, not into patching things up after they go bad?

Hospital care should be the care of last resort. When things break and diseases take hold hospitals do a good job of fixing things. But hospital type care should not be a model for how a health care system moves forward into the future.

A recent article in Health Affairs provides a description of the Hospital at Home Program. “Hospital at Home programs deliver needed services to appropriate patients in their homes and can effectively serve patients, payers, and providers. The programs provide physician visits, drugs, monitoring, nursing services, diagnostics, and other services at a level typically reserved for patients in inpatient settings. A typical Hospital at Home patient has features that make home care preferable, for example, they may present to an emergency department with uncomplicated, simple pneumonia, have no significant comorbidities, and live with a partner who can provide basic care, such as preparing meals. Studies have shown these programs have lower readmission rates, lower payer costs, and higher patient satisfaction. Patients prefer their homes, payers prefer having patients get care in the least acute setting possible, and hospital providers want to have beds available for patients who need them.”

These programs add a new level of care to a non-system that only makes things more costly and more complicated. It may appear that the home hospital concept is saving money because, on the surface, it appears people are avoiding hospitalization. But what is really happening is that a health care workforce already spread too thin is being used to create a demand for even more personnel.

Studies also indicate that the new model cannot generate enough volume to make it financially viable. So-called experts are making the case that only large hospital systems can sustain this ridiculous model that makes no sense in a world that does not have enough health care providers to provide bare-bones health care.

The concept of providing more care to people at home is a sound one. The current solution heads in the wrong direction. Instead of putting money, personnel and resources into a new level of healthcare delivery policymakers and politicians should look to what already exists. The solution is staring them in the face.

They need to put more money into home health care. Sadly, federal budgets for home health care have become a popular item for politicians to cut. They don’t understand that putting more resources into home health care saves money and improves the quality of people’s lives.

The home health care model has its roots in prevention but has been subject to death by a thousand cuts. The structure is already in place to decrease morbidity and mortality while decreasing hospital utilization by having nurses, therapists, social workers, home health aides and a host of other support staff do what they do best; treat people in their homes and prevent health problems before they happen. We should not need more hospital care. What ever happened to prevention?