by Carolyn Bennett, BSN, RN, BCPA
Long before COVID-19, predictions of a drastic health-provider shortage were brewing.
It already was common to see a lack of physicians and long waits for appointments; hospital beds closed because of a shortage of nurses; hospitals full and unable to accept new admissions.
It’s time to reinvigorate an old idea — continued care outside a hospital. Perhaps in your own home.
In the mid-20th century if you were ill you went to the hospital. New moms stayed five days after giving birth. Medical and surgical interventions required long hospital stays.
Then technology and pharmaceutical interventions grew rapidly, hospital stays shortened, and only the sickest patients were admitted. Surgery and birthing center concepts became reality so one no longer needed to be admitted to the hospital for routine uncomplicated birth or surgery.
In the 1970s, home care became a growing industry allowing hospitalized patients to go home earlier than previously imagined. New technology, especially in wound care and IV administration allowed stable patients occupying hospital beds to go home to finish therapy.
Later the development of outpatient dialysis centers allowed long-term stable kidney failure patients to be at home. The Centers for Disease Control and Prevention states 4.5 million received homecare in 2015.
It’s all about extending care beyond hospital walls.
In 1995, a Johns Hopkins medical resident asked, “Could acute medical illness that normally requires hospital admission be well managed in a patient’s home instead?”
After research and trials, the result was a 2002 Johns Hopkins Hospital at Home program. Criteria for the program includes validation of clinical appropriateness by a physician. Common reasons to deem a patient appropriate include uncorrectable low levels of oxygen, stable angina, and other multiple chronic conditions. The program must by administered by an accredited hospital.
Early studies showed that compared with usual hospital care, the new concept showed fewer complications, greater satisfaction with care, less caregiver stress, better functional outcomes, and lower costs. A 2012 Johns Hopkins study showed a 38% lower six-month mortality rate for hospital-at-home patients compared to hospitalized patients.
Fast forward to 2020. This program design has been adopted successfully across the country by several visionary hospital systems.
The greatest obstacle to overcome was payment. In response to the COVID-19 crisis, a March 2020 Medicare decision from the Centers for Medicare and Medicaid Services (CMS) allowed maximum flexibility by allowing hospital services to extend beyond their existing walls. A November 2020 CMS announcement expanded the program and began certifying hospital systems for this program.
As of Feb. 15, 2021, CMS has certified 103 hospitals in 28 states for this novel program. Arizona is NOT one of them — yet.
This will forever change the way we view hospitals. Are you ready? Keep in mind the growing number of independent health advocates, who are well informed about health systems, can provide you with information so you can make your best health care choices.
Editor’s note: Casa Grande resident Carolyn Bennett, a nurse and board-certified patient advocate, is the owner/manager of Healthmatch Advocacy (www.healthmatchadvocacy.com). The group works to help people navigate the complexities of the health-care system.
