Home Cover Story How to get hospital at home up to scale

How to get hospital at home up to scale

Expect to see patients in new settings like group homes and hotels

November 2023

ONE BIG SILVER lining that came out of the pandemic is that Medicare now pays for delivering hospital services to patients in their homes. The use of home hospital programs has since exploded—and for the first time, these programs are racking up high volumes, due to technological and staffing innovations.

Take Mayo Clinic’s home hospital program, for example, which has one command center linking patients around several Mayo sites nationwide. Since the program launched in 2020, it has treated more than 6,000 patients and saved more than 15,000 hospital bed days. Meanwhile, readmission rates for patients treated at home are lower than for those cared for in Mayo hospitals, even though the average patient acuity for home hospital patients is higher than it is for those physically hospitalized.

Michael Maniaci, MD, enterprise physician lead for Mayo’s ambitious hospital at home program, spoke at this year’s UCSF hospital medicine fall conference.

Hospital at home: Scaling up with new technology and staffing

FOR MORE THAN 20 years, hospital at home projects have posted impressive results. They’ve lowered rates of mortality, readmissions and falls; reduced incidents of delirium and infections; improved sleep and mobility; and produced better patient experience ratings.

Those outcomes have always begged the question: Why hasn’t hospital at home become more widespread? Read more here.

Hospital at home: Patients eligibility and program outcomes

home-health-patient-eligibilityWHEN THE MAYO CLINIC started its home hospital program several years ago, it focused on hospitalists’ bread-and-butter conditions like CHF, COPD and pneumonia. But the list of eligible diagnoses keeps growing and now includes post-surgical and bone marrow transplant patients, according to Michael Maniaci, MD, enterprise physician lead for Mayo’s hospital at home program.

On the other hand, exclusion criteria include uncontrolled mental illness; unstable arrhythmia; or the need for IV pain meds, telemetry, or 24/7 assistance with daily activities. Read more here.

Hospital at home: Impact on hospitalists, regulations

HEALTH CARE delivered in the home is moving fast beyond just inpatient care. Already, hospitals are experimenting with “ED at home,” bringing emergency care to patients at home with mobile imaging. Cancer centers are also starting to offer home chemotherapy.

As Michael Maniaci, MD, enterprise physician lead for Mayo’s hospital at home program sees it, “I really believe that many hospitals in the future will become surgery centers or ICUs. For a lot of the lesser acuity patients, care will be done in the home setting.” Read more here.

Phyllis Maguire is Executive Editor of Today’s Hospitalist.

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