At 86, retired nurse Eleanor McLaughlin suffers from congestive heart failure. She spent months in hospitals last year. After McLaughlin recently went to the emergency room with trouble breathing and swollen legs, she was offered the chance to return to her Needham apartment with hospital-level care. She jumped at it.
As a patient in Mass General Brigham’s Home Hospital program, McLaughlin received medical home visits twice daily. A patch on her chest measured her vital signs and transmitted them to staff, who monitored her 24/7.
One recent morning, her nurse, Marclyn Morice, spent more than half an hour drawing McLaughlin’s blood, taking her temperature, listening to her lungs, and examining her feet. McLaughlin sat in a cushioned armchair in her living room, wearing a pink flowered shirt, with MSNBC playing silently on the television. When McLaughlin said she didn’t like wearing compression stockings, Morice offered to bring her more comfortable ones. Morice called a doctor who discussed McLaughlin’s medication with her over video.
The home visits mean that McLaughlin can nap in her own bed and spend her free time taking care of chores, from balancing her checkbook to getting her leaky toilet repaired. “I can have a life as well as being taken care of,” McLaughlin said.
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Though home hospital care began about 30 years ago, programs really proliferated during the COVID-19 pandemic, when a 2020 waiver from the Centers for Medicare and Medicaid Services set criteria qualifying programs for Medicare and Medicaid reimbursement. There are now 290 hospitals in 37 states approved by CMS to provide hospital care at home — including Massachusetts General Hospital, Brigham and Women’s Hospital, and UMass Memorial Medical Center.
These programs are a win-win for patients and providers, and they should be expanded.
According to Johns Hopkins, home hospital programs save between 19 percent and 30 percent on the cost of care compared to traditional inpatient care. They lower the length of hospital stays, result in fewer lab tests, and have improved patient satisfaction and outcomes.
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Programs at Massachusetts General Hospital and Brigham and Women’s Hospital started in 2017. A 2018 study by hospital researchers found that patients in home hospital care were more physically active, got more sleep, and used fewer health care services without significant safety or quality differences. Costs for the acute care and the 30 days following a hospital stay were 67 percent lower, driven by reduced need for follow-up services and fewer hospital readmissions.
UMass Memorial, which cared for nearly 1,300 at-home patients in the program’s first 23 months, reported an 80 percent to 90 percent drop in patients needing transfers to nursing homes after a hospital stay. Mortality rates and hospital readmission rates were lower, and patient satisfaction and safety was greater.
There are also operational advantages. Eric Alper, chief quality officer at UMass Memorial Health, said the hospital instituted its program during the pandemic when the emergency department was overloaded and the hospital wanted to reduce patients’ exposure to illnesses. “We realized that you can deliver different care and even better care to patients when they’re in the home,” Alper said. A 2021 study found that Brigham and Women’s Hospital and Faulkner Hospital freed up 419 bed-days during a COVID surge by treating non-COVID patients at home.
Patients have to meet certain requirements to be eligible. Someone who needs surgery or scans cannot get that at home, but someone who needs IV antibiotics or oxygen can. The programs commonly accept people with illnesses like pneumonia, heart or lung disease, or various infections. Care is provided through a mix of in-person and virtual visits by nurses, paramedics, and in some programs physicians.
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The programs also let caregivers better understand someone’s socioeconomic needs and offer resources. For example, nurses can see if patients have healthy food at home. Stephen Dorner, chief clinical and innovation officer for Mass General Brigham Healthcare at Home, said clinicians have even identified gas leaks and insect infestations. “Being able to have that kind of vantage point, you can ensure greater health and safety of a patient as you’re tailoring their care plan to their personal environment,” Dorner said.
Additional hospitals are considering starting home hospital programs, with Beth Israel Lahey Health planning to begin one at Lahey Hospital & Medical Center in August. Susan Stempek, vice president of Hospital at Home for Beth Israel Lahey Health, said the goal is to “bring care closer to patients in their communities.”
What these programs need most to succeed is sustainable insurance coverage. The CMS waiver that allows Medicare and Medicaid reimbursement expires in 2024. With ample data showing the benefits of programs, CMS should agree to permanently pay for at-home hospital care. Making that decision soon will give hospitals the certainty they need to scale up programs.
Representatives of Blue Cross Blue Shield of Massachusetts and the Massachusetts Association of Health Plans point out that the cost of home hospital is lower, so reimbursement rates should reflect that. Today most commercial insurers pay less for home hospital care than hospital-based care.
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As Massachusetts struggles with high health care costs, home hospital programs provide a rare opportunity to achieve cost savings while improving care. That’s a win for everyone.
Editorials represent the views of the Boston Globe Editorial Board. Follow us @GlobeOpinion.
