hospital at home

AS WE BEGIN EASING back into many of the societal norms we enjoyed pre-pandemic, we can’t take for granted the lessons learned about the importance of meeting patients where and when they need care. Chief among these are the proven ways we’ve seen alternative models of care benefit our patients and care teams and deliver care to patients in a more integrated way than ever before.

Reimagining the role of inpatient care teams
Before the pandemic, I’d been working with my hospitalist teams to implement some basic telehealth applications. At every turn, we hit obstacles, from regulations to credentialing and reimbursement. While we soldiered forward, enthusiasm seemed lukewarm.

Beginning in the spring of 2020, restrictions on the use of telehealth lifted, and providers were confidently and, in most cases, eagerly leveraging virtual platforms to deliver care. This was a lifesaver to many patients who were too sick or scared to physically present to a hospital and has opened the door for sweeping transformation.

Meeting patients where they are
Given the stakes, it’s imperative that health systems shift to more flexible care delivery models that meet patients where they are. In practice, this means expanding telehealth access and even providing a “virtual front door” that navigates patients to the most appropriate care setting (telehealth, urgent care, ED, etc.). This shift impacts hospital medicine as well, as patients can be discharged from the ED to their homes for “inpatient” monitoring and treatment.

Physicians…are best positioned to identify pain points and solutions that transform hospital care for the better.

For example, to increase hospital capacity in California’s Central Valley, Vituity and Adventist Health partnered to establish the Hospital@Home program. Stable patients with appropriate diagnoses are transported home, where they are managed virtually by the hospitalist team. They also receive in-person visits from mobile nursing teams and ancillary services units. If concerns arise, patients have access to a virtual call button monitored remotely by a registered nurse.

Physician-owned groups such as Vituity are well-positioned to control their costs, which insulates their hospital partners in volatile markets. At the same time, physician owners know that while take-home pay may fluctuate somewhat with the economy, their jobs remain secure. In fact, Vituity has recruited many hospitalists recently laid off by hospitals and corporate employers.

Clinical leadership will drive the future
While it’s interesting to imagine the future of hospital medicine, the fate of our specialty ultimately lies in the hands of empowered and engaged physicians. Physicians represent our closest connection to patients and are best positioned to identify pain points and solutions that transform hospital care for the better.

To expand on the concept of virtual care, health systems are increasingly utilizing technology to not only treat patients in their homes but leverage a national workforce of providers so that we no longer need everyone in the same community. We can reach areas that have historically been too difficult to recruit by enabling providers to live where they want yet treat patients locally. This expands patient access to care, particularly in underserved communities. And this flexibility for providers means that patients in more rural areas can have access to specialist providers without having to travel far distances.

In addition to this shift outside the hospital and the increasing use of technology such as telemedicine, hospital medicine needs to transform our business model. As hospital margins continue to shrink, we need to be open to alternative payment models and staffing structures that focus on quality of care as well as cost of care reduction.

Thinking further out, I can envision a future when hospitalists leverage the capabilities of artificial intelligence (AI) to aid with data entry for electronic health records (EHRs). This would then open up hospitalists’ time and resources to be a strategic reviewer and interpreter of data and use their findings to help influence the management of conditions, patients, and care teams. Our future state is limited only in how wedded we remain to today’s definition and role of a hospitalist.

Commitment to health in place
For nearly 50 years, Vituity clinicians have led the transformation of acute care. From some of the early efforts to create pre-hospital triage systems in the 1970s to the rapid scaling of surge hospitals during the COVID-19 pandemic, Vituity clinicians and practice leaders are on the front lines of designing new ways to deliver care.

As a physician-led and -owned partnership, our culture and philosophy are grounded in a commitment to making healthcare quicker, more effective, and more accessible at hospitals and health systems across the country. As we remake care delivery for the future, Vituity hospitalists are empowered as partners to lead the design of new roles for inpatient physicians, with the backing and support of an organization dedicated to patient-centered care.

Join the team that’s transforming healthcare. Explore our hospitalist job openings.

About the author

Joshua Niebruegge, MD, is vice president of Hospital Medicine Operations at Vituity. He currently practices at HSHS St. Elizabeth’s Hospital in O’Fallon, IL. He graduated medical school from the University of Illinois at Chicago and attended residency at Saint Louis University Hospital.

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July 2021 1:55 pm

Great content! Keep up the good work!