Much of the effort to tame health spending has focused on reducing inpatient hospital use, reducing lengths of stay, avoiding overnight stays for even relatively complex surgeries, and working to prevent readmissions. Another approach is to use a patient’s home as a setting for fairly intensive acute care. A new study in JAMA Internal Medicine reports results from a CMS demonstration of use of hospital-at-home bundled with post-acute care. (JAMA Int. Med. Article) The study had 295 patients in the intervention arm and 209 who got usual care and served as the control group. The hospital-at-home patients were older, less likely to have a college education and less likely to be in Medicare Advantage or have supplemental coverage. About 19 conditions, covered by 65 DRGs, were included in the study, and the most frequent admitting diagnoses were urinary tract infections, pneumonia, cellulitis and congestive heart failure. The at-home patients had daily nurse visits, constant monitoring and appropriate equipment placed in the home. The hospital-at-home group was about half as likely to have a 30-day hospital readmission and a third less likely to have an emergency room visit following discharge from the acute (typically inpatient) phase of their treatment. They were also much less likely to be transferred to a skilled nursing facility, but more likely to be referred for home health services. This group also had a higher overall rating for their care and rated communication with clinicians and about medications better than did patients in the control group. Pain control was rated worse by the at-home patients. There were few significant adverse events for patients while in the acute phase of treatment at home. The study did not provide relative spending estimates, but based on the lower utilization and the less expensive setting, there must have been significantly less spending. While clearly not appropriate for some diagnoses, hospital-at-home seems to have good potential for reducing inpatient hospital spending, which still accounts for a substantial part of total health spending.
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The Healthy Skeptic is a website about the health care system, and is written by Kevin Roche, who has many years of experience working in the health industry. Mr. Roche is available to assist health care companies through consulting arrangements through Roche Consulting, LLC and may be reached at [email protected].
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