'You can't argue with these outcomes': What happens when hospitals bring care into the home

Editor's note: This story was updated on November 8, 2017.

Second by second, minute by minute, the United States is getting older.

"Every eight minutes, someone in the United States turns 65," Christina Wild, an expert with Advisory Board's Population Health Advisor, tells the Daily Briefing.

Get the cheat sheet: What you need to know about geriatrics

That has big implications for health care providers. Older patients are at higher risk for falls, infections, and readmissions—and as more hospitals take on risk-based contracts, they'll increasingly bear the cost of treating this complicated, costly population.

So it's critical, Wild says, that hospitals identify better ways to care for older patients.

By default, many providers funnel sick geriatric patients into hospital beds for inpatient stays or into nursing homes for post-acute care. But these forms of care are expensive—the typical inpatient geriatric stay costs $13,000—and they don't always lead to better outcomes.

Bringing care home

But according to Wild, some institutions have uncovered a better approach: specialized care teams that tend to geriatric patients in their own homes.

The eight-hospital, New Mexico-based Presbyterian Health Services system, for instance, offers inpatient-level care at home. Patients must have a qualifying condition, such as COPD or cellulitis, and must meet other requirements, including living with 25 miles of a Presbyterian Hospital ED. Among eligible patients, 92 percent choose home-based acute care over hospitalization.

"These patients are admitted to the hospital, at home," Wild says. "They receive the same level of care and the same treatments." A nurse and physician team visit daily to assess the patient, administer medication, conduct routine lab testing, and more.

The average "home hospital" length of stay is about three days, comparable to the time a patient would spend in the hospital. But home-based care is 19 percent less expensive, saving about $2,000 per hospitalization. 

According to Wild, the program has a 99 percent satisfaction rate. "You can't argue with those outcomes," she says.

Other hospitals have seen similar successes. Mount Sinai Health System has three "Mobile Acute Care Teams" comprised of physicians, nurses, social workers, physical therapists, and more, who can visit between two and five patients daily.

"There are patients in New York City that have lived in walk-ups their entire adult lives," Wild says. "But now, they're older and some have trouble walking  around their apartment, let alone getting safely down four flights of stairs to hail a cab to get to their doctor." Mount Sinai's program enables these patients to receive care that they may have otherwise forgone due to age-related limitations.

Hundreds of millions of dollars saved

Not only do home-based geriatric programs produce good results for patients; they save money for payers. Between 2006 and 2009, Medicare saved $670 million and avoided 20,500 readmissions by discharging chronic patients to home health services instead of traditional post-acute care models.

Wild expects many more institutions to launch similar programs. "More payers are going to be willing to reimburse for these services," Wild says, "because there are proven benefits of preventing an inpatient admission, reducing readmissions, and dramatically increasing patient satisfaction."

And as the population continues to age, demand from patients will only increase.

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