Pandemic awakens need for at-home hospital care in Northern California
With the pandemic escalating at the end of 2020, the Centers for Medicare and Medicaid Services began a temporary program to allow some non-COVID-19 patients to be cared for at their home rather than the hospital.
To help free up more hospital beds, CMS launched its Acute Hospital Care at Home program on Nov. 25, 2020, putting aside its normal regulations to allow hospitals increased flexibility. The program is available to certified-Medicare hospitals that meet stringent criteria. CMS has not yet announced an end date because the pandemic is ongoing.
However, treating acutely ill patients at their home instead of a hospital isn’t a new concept.
For more than 20 years, other countries have embraced the practice of freeing up hospital beds, keeping patients more comfortable and saving money through at-home hospital care. The model of care hasn’t been used much in the U.S. because of prohibitive government regulations.
“A lot of the (CMS) limitations are not tied to safety or efficacy or technology,” said Dr. Todd Czartoski, chief executive of telehealth and chief medical technology officer, Providence St. Joseph Health. “They're tied to reimbursement policies and regulatory policies.”
There also are just a handful of acute illnesses eligible to be treated in a home environment, such as a skin infection, congestive heart failure, asthma or chronic obstructive pulmonary disease, according to the National Institutes of Health.
But that doesn’t mean health care systems can’t take those requirements and adopt their own hospital-at-home program using a traditional payer model rather than Medicare. That’s what Providence is doing.
Doing its own thing
Nearly two years before the pandemic, Providence Health embarked on a pilot program that didn’t rely on being reimbursed by Medicare, said Czartoski. Providence officially launched its hospital-at-home program last July at Providence St. Peter Hospital in Olympia, Washington, Czartoski said. The health care system is based in Renton, Washington.
“We were planning on doing this because the ability to care for our growing communities in the facilities we have was being tested,” he said, adding that higher quality of care and lower costs were big factors. “COVID really accelerated the work and forced us to pull things together more quickly.”
Advances in technology, including telehealth and virtual care, have made providing hospital care at home more feasible, but that’s not the whole story.
“Logistically, it's very complicated,” Czartoski said, explaining such a program requires mobilizing nurses in the field and a virtual command center of hospital physicians and nurses to watch the patients 24/7 in their homes. Trained hospital nurses make one or two in-person visits each day to the patient’s home. “We also have all of the operational pieces” which include, but are not limited to, pharmacy needs, meals, infusions, bloodwork, ventilators and radiology therapies.
The nonprofit health care system, which operates hospitals across seven states, is getting ready to expand its acute care hospital at-home program system-wide, with plans to make its way to California hospitals within the next two years, he said. Providence has four hospitals in the North Bay area: Santa Rosa Memorial Hospital, Queen of the Valley Medical Center in Napa, Petaluma Valley Hospital and Healdsburg Hospital.
In addition to its own initiative, Providence is participating in the CMS program because the health care system serves numerous Medicare patients, Czartoski said.
“It made sense in terms of volume and growth, and to get as much experience as possible in this new way of delivering care,” he said.
As of Feb. 15, there were 202 hospitals in 34 states, including California, participating in the CMS program, according to the federal agency’s website. Seventeen of those hospitals are in California, including three Adventist Health hospitals in the North Bay region: Adventist Health Ukiah Valley, Adventist Health Howard Memorial and Adventist Health Clear Lake.
Cost savings or costly?
NorthBay Healthcare is preparing to apply for the CMS program while simultaneously working on developing its own acute care hospital-at-home program, said Dr. Seth Kaufman, vice president, chief medical officer and chief quality officer. It has two hospitals in Solano County: NorthBay VacaValley Hospital in Vacaville and NorthBay Medical Center in Fairfield.
While keeping eligible patients in their homes and freeing up hospital beds is an advantage, Kaufman said, cost efficiencies haven’t yet been determined.