In an effort to clamp down on readmissions, avoid financial penalties, and prevent hospitalizations altogether, more hospitals are resurrecting an out-of-date practice: house calls.
House calls are the cornerstone of the Hospital at Home project, designed by Johns Hopkins School of Medicine professor and American Academy of Home Care Physicians President Bruce Leff. "People may think of the house call as this quaint idea of a doctor heading out in his horse and buggy, but it is an excellent and necessary model for taking care of vulnerable high-cost patients," Leff told the Wall Street Journal.
Under the Hospital at Home model, insurers and health systems send teams of physicians, nurses, mid-level providers, and pharmacists to patients' homes, where they offer a range of services, including:
- Administering and monitoring medications;
- Monitoring and managing vitals, pain, and bandages;
- Evaluating patients' needs at home;
- Educating family caregivers on how to care for the patient, ensure the caregivers are equipped to provide such care; and
- Conducting diagnostic tests, including X-rays, ultrasounds, and electrocardiograms with portable equipment.
In addition, home visits offer providers an opportunity to help patients make healthy behavioral changes—such as smoking cessation.
According to the Wall Street Journal, research has shown that such programs are effective and reduce costs for hospitals. A Health Affairs study published last June demonstrated that a patient participating in a Hospital at Home program at Albuquerque-based Presbyterian Healthcare Services cost 19% less than non-participating patients who were treated for similar ailments.
Meanwhile, Cincinnati-based Mercy Health's Care Transitions program—which assigns nurses to high-risk patients in an effort to keep them out of the hospital—cut readmission rates from 16.9% in 2011 to 14.5% last November.
Both Presbyterian Healthcare and Mercy Health also found that satisfaction scores were higher among patients who were treated at home, in part because they got to spend more time with their physicians, the Journal reports.
Meanwhile, some health plans now are analyzing claims data to identify patients who are at high-risk of readmission and would benefit most from additional care (Landro, Wall Street Journal, 2/4).