Providers have always had a challenge in extending a satisfying patient experience after discharge. But what happens when inpatient care is actually delivered outside the premises with the same quality and safety levels as inside? I know that sentence may be a bit too much to digest.
The not-so-new, but currently very trendy hospital-at-home (H@H) movement has turned the economics and quality assurance aspects of inpatient care on its head.
But perhaps the more interesting and most challenging aspect of H@H is related to the transformation of the patient experience. In the old world, the inpatient had an experience within the walls of the provider and then one as an outpatient, whether fully recovered or with some form of care that did not require any semblance of literal hospitalization.
However, the H@H patient experience is hybrid. Physically out of the building but technically maintaining the rigor of care regardless of the change of venue.
Much like how employees embraced remote work, most H@H patients will tell you what a positive patient experience it is.
You can guess what their PX highlights are:
It’s quieter at home. Thank god there are no alerts and alarms going off 24/7.
Theoretically, the food is better. Despite many having a hobby of criticizing the culinary aspects of hospitals, home cooking, when prepared with the proper restrictions is probably better.
I can sleep well at home as I don’t get woken up at 4 am for them to check my vitals, dispense pills, or worse give me a sleeping pill.
I feel safer in relation to hospital-acquired infections. This is partially because I don’t have a sick roommate, but even more, I’m not in the Petrie dish that a traditional hospital can be.
My family, friends, and pets are much better for my mental health and loneliness reduction. Plus I can have more visitors with fewer restrictions.
I have greater control over my care subliminally based on the fact that it’s being delivered on my home turf. Some of us remember the difference when doctors actually made house calls.
So then what could the anxieties be that PX leaders need to address?
The complexities of choosing the right patients to have the H@H experience. Like the process of being selected to get into famous rehab hospitals, H@H will experience a similar pecking order that is not always clear to the patient who wants to “go home”. Some have referred to this as a new form of “Varsity Blues” without a sports coach!
Anxiety about the distance from sophisticated emergency equipment and ED physicians. Having been hospitalized for 100 days I recall the exhilaration of being discharged with the fear of being untethered. Remote monitoring creates patient and family anxiety, especially in settings where connectivity and bandwidth are unreliable.
Maintaining sanitization standards is more art than science in the home. Can family members handle the stringent safety standards and still have normalcy in the ‘rest of the home”?
Handoffs and continuity between a myriad of home care providers who are not tightly integrated will be key considerations. In the hospital, all of the handoffs are in my case right down the aisle at the nurse manager’s desk. Home handoffs may require time-consuming transportation from the nurse/clinician’s locale to the home…with traffic!
Training of family and clinical support teams will be foundational in the H@H environment. The family will have various learning styles and time to do the onboarding required. Clinicians will need to re-learn many of their skills when applied to off-premises care. This home care nursing is not new, but the nuances of hospital-at-home versus home care are significant, especially as related to reimbursements.
There is no off-hours pharmacy in the home. This may sound picky but we all know the challenges of getting prescriptions filled at a pharmacy when we’re healthy. In the hospital, the night shift can fill the orders; at home, it gets a bit more complicated at 3 am.
The illusion that the patient is healthier because they’re at home and not on-premises can not be underestimated. Typical patients become emboldened simply by getting home and this is a good thing. The mental health of H@H patients will need to include the fact that they’re still in the hospital but the “enforcement branch” for various care aspects is not present.
Finance and Capital Development directors will need to make some serious decisions about spanking new wings for inpatients when those same patients could be moved home. This will clearly be an advantage for providers who have bed shortages, but not as much for the economics of rooms becoming empty for longer periods,
Most importantly, assuring a reimbursement model for patients, hospital finance and HCAHPS satisfaction will become increasingly important. There are already many requirements that are related to these newly extended federal reimbursements. But with increasing pressure from the new Congress to scrutinize healthcare spending. H@H will not get a free lunch because of its popularity. We’re already seeing increased scrutiny of telemedicine after the spending largess during the pandemic.
If you’re interested in joining or adding to the conversation about the challenges and opportunities for H@H with your peers, register for the Hospital @ Home Leadership Summit in Boston and virtually on this Network.
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