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As I listened to speakers at the Hospital @ Home Leadership Summit in Boston this past June, I realized one of the most used words was “cars.” From my previous experiences in the healthcare market, I knew very well the critical importance of patients being transported to care settings, especially in areas where car ownership was low. But this was different.
With Hospital at Home (H@H), cars don’t relate to patient transportation — but to clinician and nurse transportation to a high-acuity home care setting.
So one of the most interesting metrics you hear from H@H strategists is how many cars they have to service patients in their homes. But much more critical is the backend organization that schedules the cars and coordinates the variety of clinicians that need to be in each vehicle.
Those contemplating H@H might consider this a luxury in a world where these teams can just drive in their cars to the patient setting. However, because of rigid reimbursement requirements, documenting the exact level of reliable visits every day becomes critical from an outcomes and financial perspective.
Why do H@H companies and providers prefer to have teams travel together?
The first is to reinforce that they are a team. It would otherwise be the equivalent of firefighters or EMTs traveling to a fire or emergency in their own cars. The car time permits the ability to discuss the upcoming home visit in much the same way as having a morning huddle in the hospital ward.
Next, from a coordination point of view, having all the caretakers leave from the same point eliminates the need to synchronize multiple starting points at peoples’ homes or healthcare enterprises. While the “company vehicle” could fall victim to traffic, it is more reliable than having four care providers arriving at different times.
Unrelated to patient outcomes is the fact that the H@H car or van is a great branding tool. In recent decades, house calls have been unheard of. Seeing the branded vehicle from a local healthcare provider or H@H vendor reinforces the much-touted “treat patients where they are” mantra.
Finally, transportation infrastructure must be taken into consideration at the very beginning of the H@H exploration stage. It goes without saying: the broader the footprint for care delivery, the greater the scheduling and clinical resource challenges. In other words, making five H@H calls per day in a rural area is very different from the same number of calls in an urban environment.
As a side note, the more rural the calls, the more attention must be given to the type of vehicles used for the call. One H@H doctor quickly learned that his Prius couldn’t take him up a bumpy hill to a patient’s country home. He reinforces that the intake forms for potential H@H patients should include the geography of the patient setting the caretakers are traveling to.
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