Ohio State Executive Says Hospital at Home Has Bright Future

Factors supporting the hospital-at-home trend include an aging population, advances in technology, and the search for more value in healthcare.

The Ohio State University Wexner Medical Center is bullish on hospital-at-home care.

The Medicare waiver for 24-hour nursing in hospital-at-home care has been extended until December 2024. With waivers granted by the federal government since the beginning of the coronavirus pandemic, more than 100 health systems across 37 states have launched hospital-at-home programs.

Ohio State launched its Hospital Care at Home program in January. The Medicare waiver for 24-hour nursing in hospital-at-home care is a good sign, says Rachit Thariani, chief administrative officer for Ohio State's Post-Acute and Home-Based Care Division. "In general, I feel confident that payers will cover this care. However, because this is still a somewhat evolving model of care, this two-year window provides a great opportunity for all of us who are in this space to comprehensively assess the value that this program creates. The value equation is always going to be the cost at which we provide the care and the quality and outcomes associated with this program."

Hospital-at-home programs need to generate data that shows the programs are effective, he says. "If the healthcare industry and the folks who are in this space can design and generate that evidence, we can prove that it is comparable to alternative models. Then I feel good about the fact that we will continue to see payers and the Centers for Medicare & Medicaid Services make this part of the mainstream of how healthcare is delivered."

There are four factors that indicate hospital-at-home care will be a trend in the future, Thariani says.

• "First, you can look at the demographic changes and the aging population. Currently, about 17% of our population is above the age of 65. It is projected by 2040 that we will see about 81 million people who will be above the age of 65. It is one of the fastest growing segments of our population, and if you think about the needs of that population, hospital at home is perfectly suited to that population."
   
• "The second piece is technology, which has come a long way and it is getting further and further advanced. That allows us to do things in the home that were not possible even five years ago. The advances in technology will help deliver higher acuity care models in the home."
   
• "Third, there is a constant search for higher value in healthcare. Value is better outcomes at a comparable or lower cost point. As health systems and other players in healthcare such as payers and employers search for higher value, models such as hospital at home will be extremely interesting to them."
   
• "Fourth, we have some large health systems making significant investments in hospital at home, so it is not something that we should under-estimate because those investments help develop the processes and technologies. Those investments help create a significant infrastructure that we can deploy for this model and understand its true efficacy."

Ohio State's hospital-at-home model

The Centers for Medicare & Medicaid Services (CMS) launched its Acute Hospital Care at Home program more than three years ago. Ohio State has embraced the CMS model, Thariani says. "In our hospital-at-home model, we have modeled it around what the CMS waiver permits. A patient needs to originate either in the emergency department or an inpatient setting and we can discharge them early to home. … The requirements are that there should be a daily provider visit, which could be completed by a physician remotely or an advance practice provider or a nurse practitioner in person. There is also a requirement for two daily visits completed in person by a registered nurse and potentially by an emergency medical technician. The requirements also state that we have access to care providers 24/7 for patients who are admitted to the program."

To provide staffing for Ohio State's Hospital Care at Home program, the organization has partnered with Dispatch Health, he says. "They recruit the physicians, nurse practitioners, and registered nurses for us. They are the ones who are seeing patients in the home. The services that Ohio State provides directly include pharmacy dispensing services, durable medical equipment, and physical, occupational, and speech therapy. It is kind of a hybrid model that includes clinicians who are employed on our behalf by Dispatch Health and certain services that we can provide."

Dispatch Health provides a 24-7 command center that is staffed by registered nurses, Thariani says. The command center oversees remote patient monitoring and interacts with the patients virtually.

Dispatch Health plays a key role in remote patient monitoring and patient data collection, he says. "As part of our relationship with Dispatch Health, they work with a remote patient monitoring company. When a patient is transferred to hospital at home, each patient receives a cellular-enabled tablet, and the tablet can constantly gather patient readings and vital signs. All of the documentation goes into our electronic medical record system—Epic. So, the data either goes directly into Epic, or when the in-home care team is with the patient, they go into Epic and conduct documentation. Our folks back in the hospital can understand what is going on with a patient at any given point in time."

Ohio State is collecting data for several hospital-at-home metrics, Thariani says. "CMS requires three metrics—patient volume, care escalation rates (how many patients were admitted into the hospital-at-home model but had to be brought back to the hospital), and mortality. However, we are working toward capturing a more comprehensive set of metrics. These include operational metrics such as length of stay and additional quality metrics such as readmission rates, infection rates, and falls. We are also collecting patient experience metrics such as patient satisfaction."

Related: Health First Sees Success With Hospital at Home Program