A “hospital at home” pilot program, tested by one New York healthcare system, reduced transfers to skilled nursing facilities, a new study finds.
The program could potentially trim $45 million from the Medicare coffers by keeping some patients out of a SNF, according to the study shared by the Mount Sinai in JAMA Internal Medicine Monday. The program involves providing hospital-level services in a patient’s home for select acute illnesses. Testing the offering out with some 500 Sinai patients between late 2014 and August 2017, the seven-hospital Manhattan system found that using “hospital at home” meant that only about 1.7% of patients ended up in a skilled nursing facility, compared to 10.4% in the control group. It also spelled shorter lengths of stay, lower rates of hospital readmissions, and less use of the emergency department, researchers found.
“When you compare the patient treated in a hospital versus the home, the improvements are overwhelmingly positive from the point of view of clinical outcomes, patient safety, patient satisfaction and cost savings,” Albert Siu, M.D., chair emeritus of the Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, said.
Researchers said about 575,000 Medicare patients could qualify annually.
In the program, a doctor or nurse practitioner provides acute care services to the patient at home, with a nurse visiting at least once a day. The physician or nurse practitioner sees the patient daily in person or through video. Medical equipment is provided at home when necessary. After the patient has recovered, the 30-day post-acute care period begins. That’s when nurses and social workers provide support and coordination with primary care, rehab, specialists and outpatient testing, when it’s needed.
Those involved say that Health and Human Services’ secretary is interested in scaling the model, and has asked Mount Sinai to help further develop a home-based hospital care model.