As the HLTH conference kicks into gear in Las Vegas, Kaiser Permanente has launched a collaboration with Instacart to study how access to nutritious food can improve care management and clinical outcomes for those with chronic diseases.
Healthcare organizations are taking a closer look at the “food as medicine” concept in an effort to curb skyrocketing care management costs.
One of the front-runners is Kaiser Permanente, which announced a collaboration with grocery technology company Instacart to study how access to nutritious food and resources on healthy eating can affect clinical outcomes. The study will focus on California residents enrolled in the state’s Medi-Cal Medicaid program who are living with chronic conditions like diabetes and heart failure.
The announcement also comes in advance of HLTH, the massive health conference taking place this week in Las Vegas that shines a spotlight on the expanded health and wellness ecosystem. Food as medicine (also called “food is medicine”) was a popular topic at last year’s event and is just as evident this year, with an entire row of booths devoted to the concept, and healthcare executives are looking at how this particular social determinant of health can reduce long-term care management costs by improving clinical outcomes.
"We know that without access to nutritious food, individuals are less likely to stay healthy, increasing the likelihood of new and widening health disparities and healthcare costs," Anand Shah, MD, the healthcare organization’s vice president of social health, said in a press release. "This innovative study is one of the many avenues that we're pursuing to improve the health of our members and communities with diet-related diseases."
Kaiser Permanente has been invested in this strategy since 2022, when it launched a $50 million “Food is Medicine” initiative in conjunction with the White House Conference on Hunger, Nutrition, and Health. The Instacart partnership is the next stage in that effort, and comes as Medicaid programs across the country are developing new programs to qualify for innovative Section 1115 research and demonstration waivers from the Centers for Medicare & Medicaid Services.
The collaboration will give selected Medi-Cal members the resources they need to purchase nutritious food that matches their care plan. Care providers will then track clinical benchmarks such as blood-sugar levels, health concerns that require visits to the doctor or hospitalizations, and other benchmarks that focus on food insecurity, diet-related disease quality of life, and patient engagement and readiness to change habits.
"We know food and nutrition insecurity is felt by people in the communities we serve, as well as for by millions of Americans nationwide," Pamela Schwartz, MPH, executive director of food security at Kaiser Permanente, said in the press release. "Identifying best practices to address these inequities is essential to building healthier communities."
There are, of course, questions that come with the program. Can the benefits be measured in such a way to produce ROI and support sustainability? Will healthcare organizations support helping patients map out their meals? And will enough patients follow the program to show success at scale?
The Kaiser Permanente study is just one facet of a much larger national effort to address the many different factors that make up SDOH.
Recently, WellSpan Health became one of three health systems to earn health equity accreditation through the National Committee for Quality Assurance (NCQA). The accreditation addresses a broad range of SDOH elements and pushes health systems to develop a comprehensive strategy.
"Throughout the country, there are disparities in life expectancy based on whether you live in an urban or rural area, whether you have access to education, whether you have access to housing, and whether you have access to healthy food,” Michael Seim, MD, senior vice president and chief quality officer of the Pennsylvania-based health system, said in a recent HealthLeaders article by Chris Cheney. “So, we are working on this issue as part of our community health needs assessment, our community health improvement plan, and our strategic plans. We are trying to look at all angles, including through a lens of equity."
"That focus is innovative in the fact that we have to tie together every aspect of not only our clinical practices within WellSpan but also within our community health work and our partnership programs," he added.
The agency is once again extending a pandemic-era waiver enabling providers to prescribe controlled substances via telemedicine without first needing an in-person checkup, and is expected to propose new long-term guidelines soon.
Federal officials are extending pandemic-era flexibilities for prescribing controlled substances via telemedicine through the end of 2024.
“We continue to carefully consider the input received and are working to promulgate a final set of telemedicine regulations by the fall of 2024, giving patients and medical practitioners time to plan for, and adapt to, the new rules once issued,” DEA officials said in a post on the agency website.
The news isn’t surprising. The agency has been under fire for not developing a special registration process for telemedicine prescriptions, and rules proposed earlier this year to help providers use telemedicine for prescribing controlled substances were roundly panned by advocates who said they were more restrictive and confusing than what had been in place before the pandemic.
Nathaniel Lacktman, a partner with the Foley & Lardner law firm and chairman of its digital health team, said during a keynote at the Northeast Telehealth Resource Center’s annual conference last month in Nashua, New Hampshire that he expects the DEA to come up with an amended version of long-term telemedicine prescribing rules by the end of the year.
Lacktman was critical of the first DEA proposal when it was released.
"The proposed rules are intended to bridge between the DEA’s current PHE waivers and a post-PHE environment," he wrote in the firm's Health Care Law Today blog last May. "In so doing, DEA proposed creating two new limited options for telemedicine prescribing of controlled substances without a prior in-person exam. The options [are] both complex and more restrictive than what has been allowed for the past three years under the PHE waivers. The DEA’s proposal will discontinue the ability for telemedicine prescribing of controlled substances where the patient never has any in-person exam (with the exception of an initial prescription period of no more than 30 days’ supply). Moreover, if the patient requires a Schedule II medication or a Schedule III-V narcotic medication (with the sole exception of buprenorphine for opioid use disorder (OUD) treatment), an initial in-person exam is required before any prescription can be issued."
The DEA has long resisted creating a registration process even though it was mandated by Congress in 2008 through the Ryan Haight Online Pharmacy Consumer Protection Act. Telehealth advocates have long argued that providers should be able to prescribe certain medications without first needing an in-person exam as a way of expanding access to and treatment for mental health and substance abuse issues. Several members of Congress and the American Hospital Association have also chimed in, urging the DEA to take action.
The nation’s largest health system is pledging to share veteran health data with a number of large health systems across the country to improve access to care regardless of whether it’s in a VA facility.
The Department of Veterans Affairs is making a bold pledge toward data interoperability for the nation’s 16.2 million veterans.
The nation’s largest health system announced today that it will support data-sharing with 13 community health systems across the country, enabling veterans and their care teams to access data regardless of whether it’s stored in a VA health system.
“This pledge will improve veteran healthcare by giving us seamless, immediate access to a patient’s medical history, which will help us make timely and accurate treatment decisions,” VA Under Secretary for Health Shereef Elnahal, MD, said in a press release. “It will also empower VA to send helpful information to our partner health systems that they can then offer to veterans in their care — including information about new benefits we are offering under the PACT Act, no-cost emergency suicide care, and more.”
The health systems that will share veteran information with the VA are:
Atrium Health
Emory Healthcare
Inova
Intermountain Health
Jefferson Health
Kaiser Permanente Health Plan and Hospitals
Marshfield Clinic Health System
Mass General Brigham
Rush Health
Sanford Health
Tufts Medicine
University of California, Davis Health
University of Pittsburgh Medical Center
According to the pledge, the VA will:
Enable health system application access to authoritative VA resources to determine veteran status.
Enable automation of benefit eligibility determination and referrals.
Enable health system application access to identify local, state, and federal health resources.
Enable VA application access to health-system clinical and administrative data for quality assessment and care coordination.
Advance and implement federally recognized, national interoperability standards, privacy and security frameworks related to the executing the pledge’s commitments on information exchange and use of health information.
VA officials told the Federal News Network that EHRs have become sophisticated enough “where the next level of innovation can really happen,” including interoperability.
“The data that we’re talking about isn’t always going to be clinical data,” an official said. “We’re very interested in what’s referred to as the administrative data, which talks about the benefits a veteran could potentially qualify for.”
“We really want this to benefit the industry as a whole,” the official added. “As the technology advances, we really feel that VA has a leadership role. As the largest healthcare system in the country, the largest payer, we absolutely feel that responsibility to get out there and lead on what this could potentially look like.”
A recent report says hospitals are seeing financial relief as operating margins stabilize, but leaders are being warned to proceed with caution.
The latest data from Kaufman Hall shows hospitals are seeing some financial relief as revenue increases offset rising expenses and operating margins stabilize, the August 2023 report says.
The median year-to-date operating margin index increased from 0.9 percent in July to 1.1 percent in August, according to the data. While these margins are still below historical levels, it's noteworthy that hospitals have consistently achieved positive margins since March.
Another win coming from the Kaufman Hall report is in revenue growth. Hospitals experienced robust revenue growth, outpacing expense increases, the report said. Net operating revenue increased by 8 percent month-over-month, while gross operating revenue rose by 9 percent.
Inpatient (4 percent) and outpatient revenue (12 percent) also posted significant gains from July to August. Hospital CFOs should continue to focus on revenue optimization strategies, particularly in the outpatient setting, where care transitions have been evident.
While margins seem to be trending in a positive direction and are starting to show a gradual recovery from the financial challenges brought on by the pandemic, CFOs are being told to remain cautious.
Ben Finder, director of policy research and analysis at the American Hospital Association, recently took aim at the “false narrative from hospital critics” that tell leaders they are in the financial clear.
“Hospital critics frequently focus exclusively on a fleeting period of stability, ignoring other available data that show the real costs of cascading waves of illnesses, inflationary pressures, and skyrocketing expenses for drugs, labor, supplies and equipment,” Finder said in his recent AHA blog post.
Taking a look at the big picture shows a much different story, Finder says.
Fitch, Moody’s, and S&P all released reports describing how nearly every metric of hospital and health system financial health declined in 2022, Finder said.
“Operating margins and earnings deteriorated significantly, days cash on hand (a measure of financial resilience) declined, and as a result, most agencies are reporting significantly more credit rating downgrades than upgrades,” Finder said.
CFOs know they need to be looking at big-picture results when examining financial health, and it’s evident that while finances have been improving, hospitals and health systems won’t be out of the woods any time soon.
The Kaufman Hall report paints a cautiously optimistic picture for hospital CFOs. Positive operating margins, efficient expense management, and revenue growth indicate a continued recovery from pandemic-related challenges, but as patients resume more typical care patterns and days of cash on hand remain low, CFOs must remain vigilant in managing costs and optimizing revenue while adapting to the evolving healthcare landscape.
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Health systems across the country are launching telemedicine programs aimed at improving the nurse's workload, but both value and sustainability are hard to pin down.
Virtual nursing is all the rage these days, with health systems across the country launching telemedicine-based programs aimed at helping their beleaguered nurses. But with no clear-cut path to ROI, executives are uncertain whether the programs can be sustainable.
Each hospital is approaching the issue from a different direction, ranging from basic telesitter programs targeting patient monitoring and fall prevention to platforms that support new nurses to more complex telenursing platforms that combine monitoring with administrative functions.
At the Medical University of South Carolina (MUSC) in Charleston, officials tested a virtual nursing service about a year ago, says Emily Warr, MSN, RN, administrator for the health system's Center for Telehealth. That program was geared toward helping new nurses learn the ropes.
Not long afterward, the program was shut down.
"We learned from that endeavor that it's not enough," Warr says. "It has to be much more complex and bring more value."
So MUSC pivoted, creating a platform designed not only to remotely monitor patients in their rooms but help with administrative tasks, from charting in the EMR to onboarding and discharges. That program will debut soon in four of the health system's rural hospitals, where the nursing ranks are especially strained.
"Bedside nurses spend way too much time in documentation," Warr says. The new program, she says, assigns those tasks to the virtual nurse, who can sit in a room in another part of the hospital and handle EMR documentation for several patients. It adds another set of expert eyes to the details that make up the patient record, while freeing up the bedside nurse to focus on hands-on duties and interactions that improve care management.
Warr says a virtual nursing program will only succeed if it addresses multiple pain points.
"This program can't just focus on workforce economics or quality [of care]," she says. "One is not enough. There has to be a quality component. We've got to impact patient care."
Warr says the biggest challenge to standing up a telenursing program is the CEO.
"They see this as an additional expense until proven otherwise," she says.
That's a common refrain in many health systems, as health system decision-makers struggle to balance new ideas and technology against a perilous bottom line.
'Things Are Changing Too Fast'
At a recent HealthLeaders Teams Exchange in Nashville, clinical and financial executives from several health systems across the country came together to discuss the challenges they face in sustaining a workforce. Virtual nursing was one of the hot topics of conversation, with nearly everyone agreeing they'll have fewer nurses in five years and nearly three quarters saying they've launched such programs to address that problem.
Telesitting, telenursing, and virtual nursing programs saw a dramatic increase during the pandemic, when hospital leadership sought to reduce contact between infected patients and their staff to curb the spread of the virus. In time, those hospitals using the platform saw benefits ranging from reduced stress on nurses to improved clinical outcomes through more consistent monitoring, resulting in more efficient room turnover, improved patient discharge rates, and better patient satisfaction scores.
And they're seeing a lot of potential in the platform, especially as health systems look to address the changing nature of the hospital stay.
"With inpatient virtual care, it opens up a lot of doors," says Colleen Mallozzi, MBA, RN, senior vice president and chief nursing informatics officer at Jefferson Health, which recently launched its Virtual Nursing Program after a trial run earlier this year involving nearly 400 patients.
"The virtual nurse can do anything except physical touch," adds Laura Gartner, DNP, MS, RN, RN-BC, NEA-BC, an associate chief nursing information officer and division director of clinical informatics at the Philadelphia health system.
Jefferson Health is launching its virtual nursing program after a four-month pilot in two units and will be watching a wide range of benchmarks that include patient length of stay, patient satisfaction, patient flow (including transfers), nurse turnover and overtime, and documentation compliance. The program will be incorporated into the wall-mounted television unit in each room, a familiar form factor for many in-patient telehealth programs.
"We want our nurses to be doing what they should be doing, which is caring for patients," says Gartner.
But a nurse can't physically be in a patient's room at all times, and with fewer nurses that time spent in the room is even smaller. Jefferson Health's program puts a nurse virtually in each room at all times, accessible through the wall-mounted TV, giving patients the comfort of knowing there's someone looking in on them and answering their questions when needed.
"It's an evolving landscape," says Mallozzi, noting the program is separate from Jefferson's 10-year-old telesitting program, which focuses solely on monitoring and safety care and has shown value in reducing patient falls.
Starting Small and Scaling Up
To be fair, telesitting, whose roots trace back to the practice of using volunteers (sometimes retired nurses) to sit with patients with behavioral health concerns or at risk of falling, has proven its value, with studies finding it reduces patient falls and self-harm and can save hospitals hundreds of thousands of dollars a year in associated costs. But those programs don't address nursing workflow or stress issues. Telesitting can be incorporated into a virtual nursing program, but it can't be stood up as a telenursing service.
Farther south, Valley Health went live with its virtual nursing program in May. The six-hospital network, serving parts of Virginia, West Virginia, and Maryland, partnered with Teladoc Health to launch a pilot in one hospital, with plans to expand soon.
"We started this way, beginning with a traditional med-surg unit, so that we would have lots of options," says Theresa Trivette, DNP, RN, CENP, the health system's chief nursing officer. "Each unit is going to have its own culture and needs … so we need to begin slowly and let our nurses [help us to] build out this model together."
Trivette says the health system saw the value of an inpatient telemedicine platform during the pandemic, and officials wanted to find a way to keep that going after COVID. Not surprisingly, executives jumped on the idea of using the platform to support nurses.
"They're getting tired, and many are considering retirement," she says. "We thought about how we could keep them in care delivery longer."
Trivette says the program focuses more on care management, with administrators inviting nurses to map out the platform and prioritize what they do in the patient's room. And while some nurses initially saw this as an intrusion that affected their job responsibilities, she says, the attitudes turned positive as the program was fleshed out to address their stresses.
She says the platform has become popular with patients (especially seniors) who just want someone to chat with each day and has led to a 20% jump in patient experience scores. In addition, it has boosted staff morale and engagement, which in turn will improve care management and coordination.
"We're focusing on supporting the whole care team, not necessarily plugging a pain point," Trivette says. "How do we help our nurses in all aspects of care delivery?
At the HealthLeaders Exchange, much of the focus around virtual nursing was on hard results, such as clinical and administrative outcomes that translate into savings. At Mount Sinai South Nassau, for example, Senior Vice President and Chief Nursing Officer Stacey Conklin, MSN, RN-BC, MHCDS, NE-BC, is working side-by-side with John Pohlman, CPA, the hospital's chief financial officer and senior vice president of finance, to make sure virtual nursing outcomes align with financial considerations.
That might include reduced patient length of stay, which improves patient satisfaction scores as well as the room turnover rate. Or the extra pair of eyes on the EMR could not only cut down on documentation time but reduce errors, improving not only the coding and billing process but clinical outcomes.
"You have to have your CFO at the table," noted Helene Burns, DNP, RN, NEA-BC, senior vice president and chief nursing officer at Jefferson Health New Jersey. "We have to think about where we invest our dollars."
The HealthLeaders Exchange is an executive community for sharing ideas, solutions, and insights. Please join the community at https://www.linkedin.com/company/healthleaders-exchange/. To inquire about attending a HealthLeaders Exchange, email us at exchange@healthleadersmedia.com.
The California health system is getting $9.5 million through an HHS program aimed at tackling healthcare data breaches, and will explore innovative solutions through its new Center for Healthcare Cybersecurity.
The UC San Diego School of Medicine is getting a federal grant of almost $10 million to study how to prevent and mitigate ransomware attacks.
The $9.5 million grant comes from the Health and Human Services Department's Advanced Research Projects Agency for Health (ARPA-H) as part of its DIGIHEALS initiative, which supports innovative projects aimed at addressing hostile cyber threats. The healthcare industry saw some 344 data breaches in 2022, according to the Identify Theft Resource Center, the most of any industry.
“Healthcare systems are highly vulnerable to ransomware attacks, which can cause catastrophic impacts to patient care and pose an existential threat to smaller health systems,” Christian Dameff, MD, an emergency medicine physician at UC San Diego Health, assistant professor at the UC San Diego School of Medicine and UC San Diego Jacobs School of Engineering, and co-principal investigator, said in a press release. “Developing protocols to protect health systems, especially rural and critical access hospitals, will help save lives and make healthcare better for all of us.”
The research will target ransomware attacks, which cost health systems, on average, $11 million a year, according to IBM's 2023 Cost of a Data Breach report. Apart from the financial toll, these attacks can also affect care delivery, and can potentially cause patient harm or even death.
“During a ransomware attack, hospitals often have to switch back to inefficient pen-and-paper methods of administration, and this slows down healthcare delivery and introduces additional risks to patient safety,” Dameff said.
“When I talk about cybersecurity most people only think about protecting patient data,” he added “That’s all well and good, but we need to be just as concerned about care quality and patient outcomes. The impacts of malware and ransomware don’t stop at the digital border of a hospital.”
Jeffrey Tully, MD, an assistant clinical professor at UC San Diego School of Medicine and co-principal investigator, noted ransomware attacks can devastate small and rural health systems, with one hospital in Illinois shutting down for good.
Dameff, who in 2019 was appointed the first medical director of cybersecurity in the nation, will conduct the study through UC San Diego's new Center for Healthcare Cybersecurity, which is supported by the Joan & Irwin Jacobs Center for Health Innovation.
“Cybersecurity in healthcare is a huge problem that can affect each and every one of us, but few healthcare systems are prepared for the consequences of cyberattacks,” Christopher Longhurst, MD, chief medical officer and chief digital officer at UC San Diego Health, said in the press release. “The new center is designed to address this unmet need, and this new research is just the beginning of that effort.”
Health Systems like Essentia Health are using specially trained EMS teams to help recently discharged patients and those with chronic care needs stay out of the hospital.
One of the biggest care gaps occurs when the patient leaves the hospital. The care team can send along instructions for care management, send texts or emails or make phone calls, even schedule follow-up care, but there's no guarantee those directions will be followed.
At Essentia Health, those patients are now getting house calls from paramedics.
The 14-hospital health system covering parts of Minnesota, Wisconsin, and North Dakota has been using community paramedicine since 2014, and has seen reductions of almost 60% in 30-day readmissions, with ED visits and hospitalizations cut in half up to three months after discharge. Brendan Krupich, the health system's community paramedic program manager, says the program has reduced costly ED and rehospitalization costs while helping patients with ongoing and acute chronic conditions improve their health and wellness at home.
"They have a continuity of care that they didn't have before," he says. "We're seeing them at home now instead of [the emergency room] and helping them to stay there."
Community paramedicine programs, part of an array of outpatient services known as mobile integrated health programs, change the paradigm of providers waiting around for patients to come to them. Most health systems with MIH programs identify patients as high-risk returnees (sometimes called "frequent flyers") and schedule visits to the home after those patients have been discharged.
Healthcare organizations across the country have been launching community paramedicine programs to reduce ED and clinic traffic, cut down on hospital admissions, and take pressure off 911 services and EMS departments swamped with unnecessary or preventable calls. They're also taking aim at soaring care management costs for Medicaid and Medicare Advantage populations, many of who either avoid healthcare visits and preventive health services or wait until it's an emergency. A 2009 Institute of Medicine study indicated roughly $750 billion was being spent on preventable services, amounting to about 30% of the nation's total healthcare costs for that year.
"We were seeing a lot of people who just waited too long" to connect with their care team after leaving the hospital, Krupich says. Some, he says, are too stubborn to seek additional care, while others don’t think their concerns are serious enough to warrant a phone call or trip to the doctor. In today's economy, the sting of another medical bill hangs over the household.
Krupich launched his program with a one-year state grant, aiming to cut 30-day readmissions in half. Patients were identified through the EMR, and scheduled for home visits from specially trained paramedics who are employed by the health system (some programs use their own paramedics, while a majority work with local EMS and ambulance departments).
"We really needed to get buy-in from home health [agencies], and that took a while," he says. "We weren't replacing what they were doing."
In fact, MIH and community paramedicine programs can supplement home health services. They also can be used in acute care at home programs, fulfilling that in-person link and giving patients a personal connection to their care management plans. The goal is to connect patients to their care plans in a more meaningful way, encouraging them to follow doctor's orders and embrace healthy habits.
Krupich says his community paramedics go into a patient's home focused on emphasizing such things as medication adherence, exercise, and nutrition. While there, they can also identify and perhaps address social determinants of health, as well as connect the patient with community health and social services resources, including behavioral healthcare.
"Honestly, that's a large part of what we're doing now," he says. "We can't claim all the successes, as there are a lot of moving parts in this."
Krupich says the program is well-received by patients and providers alike because it reinforces the human touch in healthcare, giving the health system an opportunity to get more acquainted with the people they see so often in the ED. The key, he says, is training EMS staff to make those connections and understand what patients need at home.
“I refer to them as a bit of a Swiss Army Knife,” Chris Anderson, MD, Essentia's EMS medical director, said in an August 2023 news release issued by the health system. “Their skill sets are broad and they often work under the radar because their patients interact with practitioners less frequently once the community paramedic establishes a relationship.”
"Essentia's community paramedics play an indispensable role in reducing cost of care by decreasing ED and hospital admissions," Anderson added. “Our community paramedics often develop lasting relationships with their patients, which allows patients to better understand and participate in their own care."
The challenge sustaining these efforts, Krupich says, is funding. Essentia Health has received grants to keep the community paramedicine program going, targeting expensive benchmarks for certain chronic care populations like those living with diabetes. The Centers for Medicare & Medicaid Services (CMS) does not reimburse health systems for community paramedicine visits, and recently ended a pandemic-era alternate payment model that would have reimbursed for some programs that divert care from the ED.
But the tide is shifting, as more health systems look to reduce unnecessary expenses in the ED and focus on making hospital beds available for those who need to be treated in a hospital. Krupich says the Essentia Health program has reduced unnecessary hospitalizations and readmissions, and some payers, such as Blue Cross Blue Shield, are taking notice.
"We are moving forward," he says. "I see us taking more of a proactive approach to EMS services. We've been so reactive for so long and haven't done anything to fix it."
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The health system, one of the first to launch an acute care at home platform, has received federal and state approval to treat patients from three more hospitals in their own homes.
Mass General Brigham has received federal and state approval to expand its Hospital at Home program to include patients from three more hospitals.
Health system officials have announced that Newton-Wellesley Hospital, Salem Hospital, and Brigham and Women's Faulkner Hospital will join the Home Hospital program, which was launched by both Massachusetts General Hospital and Brigham and Women's Hospital in 2016 and consolidated in 2020 when the two hospitals merged.
"We are incredibly proud of the impact that Home Hospital has had on its patients, as well as our care teams across Mass General Brigham,” Heather O’Sullivan, MS, RN, A-GNP, president of Mass General Brigham Healthcare at Home, said in a news release issued earlier this month. “This expansion is an exciting opportunity to provide greater access to the integrated, high-quality care we offer to even more patients in our surrounding communities."
Acute care at home and the CMS-approved Acute Hospital at Home programs enable hospitals to provide care for patients in their own homes instead of the hospital setting. The platform combines remote patient monitoring and telehealth technology with scheduled daily in-person visits. Health systems that follow the CMS model must adhere to strict guidelines to qualify for Medicare reimbursements.
The concept gained momentum during the pandemic as a means of helping overcrowded and workforce-thin hospitals care for COVID-19 patients at home, reducing the risk of infection. During the pandemic, CMS activated special waivers to enable more hospitals to qualify for its Hospital at Home program, and more than 220 health systems have followed that model. Those waivers are scheduled to end with the 2024 calendar year, though supporters are lobbying to make them permanent.
Many health systems – including Mass General Brigham, which has treated more than 3,000 patients at home, including nearly 1,000 this year, and is considered to have one of the oldest programs in the country – have developed their own protocols to treat a wider variety of patients at home, including those with chronic care needs.
“Being able to have that kind of vantage point, you can ensure greater health and safety of a patient as you’re tailoring their care plan to their personal environment,” Stephen Dorner, MD, MPH, MSc, chief clinical and innovation officer for Mass General Brigham Healthcare at Home, said in the release.
According to David Levine, MD, MPH, clinical director of research and development at Mass General Brigham Healthcare at Home, the program has shown benefits in a number of clinical outcomes, which Levine and his colleagues have reported on in studies. Levine says those outcomes include clinical quality measures, "enhanced patient and employee experiences, and increased capacity and access to inpatient care, [as well as] greater visibility into a patient’s socioeconomic needs and offers additional resources to support their care."
Mass General Brigham's program includes daily in-person or virtual visits from a nurse practitioner, physician assistant, or physician, as part of a larger care team that includes paramedics, nurses, therapists, and home health aides. According to the press release, "services provided include intravenous fluids and medications, laboratory testing, oxygen, radiology studies, electrocardiograms, and ultrasounds directly in the home. All of this is supported by a 24/7 continuous remote patient monitoring platform that transmits a patient’s vital sign readings to their clinicians as well as a two-way text and video communication pathway that ensures continual access to a patient’s clinical team."
The health system currently is approved to care for 33 patients at home and is expanding to serve up to 45 patients. Officials say they expect to shift 10% of inpatient care at Mass General, Brigham and Women's, Newton-Wellesley, Salem and Women's Faulkner to the home setting within the next five years.
