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Tampa General's TGH at Home Program Brings Acute-Level Care to the Patient's Home

Analysis  |  By Jasmyne Ray and Eric Wicklund  
   January 26, 2023

The hospital is one of hundreds to launch an Acute Hospital Care at Home Program, which combines telehealth and remote patient monitoring with in-person visits.

Tampa General Hospital in mid-2022 launched TGH at Home, a partnership with the Visiting Nurse Association (VNA) to provide in-patient-level home care to the patients in its community.

Using remote patient monitoring and telehealth technology and home health visits, the hospital's physicians can receive real-time health information about a patient who is ill or recovering at home. Combined with in-person care, Tampa General can manage care for patients in their home who would otherwise be hospitalized.

These efforts began during the COVID-19 pandemic, during which the hospital created a transitional care team to create space for the growing number of patients who needed care. Prior to COVID-19 there was no team to monitor remote patient data.

The program is supported by the Centers for Medicare & Medicaid Services (CMS), which created the Acute Hospital at Home Program during the early stages of the pandemic to help hospitals better handle the surge of acute-care patients and care for some of those patients at home.

CMS has created waivers for the program that expand the use of and Medicare coverage for telehealth services, and Congress recently mandated that those waivers will remain in place until the end of 2024. To date, more than 220 health systems are taking part in the program, many of which have modified the model to fit their specific needs.

Peter Chang, Tampa General's vice president of care transformation, says TGH at Home gives the hospital an opportunity to extend care to the home setting, a setting that many expect to become more prominent in the health system of the future.

"I never had a team to be able to monitor the outputs," Chang said. "As COVID hit, that was the 'silver lining' as I always call it, because it gave me the opportunity to go to our CEO and ask for support with our ambulatory leader to create that transitional care team."

One that team was in place, "the idea was that if we can discharge a patient earlier from a COVID perspective, by setting up telehealth, phone calls, or remote patient monitoring to look at oxygen levels, then let's do it," he said.

In-Patient Care at Home

Patients who qualify for the TGH at Home program are typically acute care patients who are either hospitalized or come into the Emergency Department. They must be evaluated by TGH and meet a strict set of criteria to enter the program, which basically means they're able to receive acute-level hospital care at home.

"There's a ton of inclusion [and] exclusion criteria to make sure it's safe to care for that patient at home; both from our team perspective and, most importantly, that patient's perspective," Chang said. "We actually lend a 4G LTE tablet to the patient and have a Bluetooth patch that measures vitals at intervals of every five seconds. We can also get a continuous EKG on the patient if they need it too."

As part of the Acute Hospital at Home Program, CMS mandates that the health system send care providers to the patient's home on a regular basis, usually every other day, while telehealth visits are scheduled at least twice a day. Chang says nurses sent to the patient's home for those in-person visits provide home IV antibiotics, oxygen therapy and wound care, and medication management, all tasks that can't be done via digital health or RPM.

Some Barriers to Overcome

Chang says there have been some challenges to remote patient monitoring, such as the supply and distribution of technology. The clinical team can't pack and ship devices to patients, so the hospital partners with companies in the remote patient monitoring space to distribute the devices. These companies also provide technical support.

"As you can imagine, all the technical support issues you would have with technology, that sort of transcends into remote patient monitoring," Chang explained. "So the companies that we partner with have the infrastructure to distribute the devices and also support the devices with their troubleshooting issues."

Connectivity is also an issue, in both utilization and cost. Some programs rely on wi-fi connectivity, though that's dependent on broadband accessibility. Others, like the Tampa General program, use cellular connectivity.

With TGH at Home, the patient is responsible for configuring the device so that its cellular signal will send the output and be visible to the transitional care team monitoring it.

"Some of the devices we've looked at have cellular chips embedded in each device. Now that's not the most cost-effective because if I have three devices at a patient's home, that's three cellular plans that I need to support," Chang said. "We've looked at a couple of different technologies that we can preconfigure in one cellular device and link four cellular devices to that one cellular device to submit all the data to our transitional care team."

“The idea was that if we can discharge a patient earlier from a COVID perspective, by setting up telehealth, phone calls, or remote patient monitoring to look at oxygen levels, then let's do it.”

Jasmyne Ray and Eric Wicklund are editors for HealthLeaders, an HCPro brand.


KEY TAKEAWAYS

Hospital physicians recieve patient health information in real time via remote patient monitoring and telehealth technology.

The TGH at Home program is supported by the Center for Medicare & Medicaid Service's Acute Hospital at Home Proogram, which began during the pandemic.

The supply and distribution of technology, as well as connectivity, are some of the challenges the program has faced.


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