By Tami Kamin Meyer
Rachit Thariani, chief administrative officer of The Ohio State University Wexner Medical Center’s Post-Acute and Home-Based Care Division, says he is “optimistic” about the future of acute home healthcare.
When Ohio State launched its Hospital Care at Home program in January 2023, it became the latest entity to join Thariani’s department to bolster Ohio State’s efforts in assisting qualifying patients with convalescence at home rather than in the hospital.
“As our population ages, we need to provide care where patients want it versus where the healthcare system wants to provide it,” Thariani says. “Patients want to receive care closer to where they live, shop and work.”
The future of acute at-home health care
There are currently 124 systems and 278 hospitals in 37 states offering acute at-home health care as part of their slate of medical services, according to the Center for Medicare and Medicaid Services (CMS).
And those numbers are bound to increase.
In 2022, McKinsey and Company, a global management consulting firm, released a survey of physicians who serve predominately Medicare fee-for-service and Medicare Advantage patients. Based on those results, McKinsey estimated upwards of $265 billion worth of care services for those patients could shift from traditional healthcare settings to the patient’s home by 2025.
Thariani attributes his bullishness on the increasing need for acute at-home healthcare to three main factors:
- America’s aging population
- The unheralded advancements in technology that permit healthcare at home to become more convenient while increasing the accessibility of healthcare for more people
- Improved medical outcomes for patients
How Medicare and Medicaid fit in
The Medicare waiver for all types of home healthcare instituted during the early days of the COVID-19 pandemic has been extended until December 2024. What that means to Thariani and others involved in acute at-home healthcare is that such programs have just over 18 months to compile evidence and statistics supporting the public’s need for home-based acute medical services and the ability of each offering to succeed.
With the CMS waiver in effect until the end of next year, Thariani says, “this is a great opportunity for entities like us to prove the efficacy of programs like this. We have to generate evidence that it works.”
Staffing considerations
When Ohio State launched its Hospital at Home program, it partnered with Dispatch Health, which provides all the medical staffing needed to support OSU’s program.
“They are here for staffing, remote patient monitoring and 15 days post-discharge care,” says Thariani.
Ohio State contributes its Pharmacy-at-Home, durable medical equipment, and physical therapy services.
According to Thariani, any medical staff provided by Dispatch Health must undergo the hospital’s onboarding process. Particular attention is paid to teaching healthcare providers how to use the facility’s Electronic Medical Records (EMR) software.
However, staffing shortages are a constant sore spot for some private acute at-home healthcare service companies.
“It’s hard to recruit and retain workers,” says Renee McInnes, RN and CEO of Massachusetts-based NVNA and Hospice. “There are not enough nurses nationwide. We are struggling like everybody for the demand that’s out there.”
McInnes attributes the staffing challenges her company faces to several factors:
- Her company pays less than hospitals
- Her entity is not unionized
- The medical services provided by her staff represent a “different type of nursing” than hospital positions
She also points to the benefits her staffers enjoy over hospital healthcare staff. They include “patient and employee satisfaction and shorter commutes” to see patients. Moreover, employees enjoy greater schedule flexibility than most hospital healthcare workers, she notes.
Although her New York City-based healthcare staffing firm, Galaxy Home Care, is unionized, CEO Yelena Sokolsky echoes McInnes’ staffing woes.
“I’ve been doing this for 20 years, but this is the most difficult time to find staff. People completely lost their work ethic, respect for patients, (while gaining) feelings of entitlement” due to the pandemic, she says.
Cannibalize or complementary?
Both Sokolsky and McInnes agree the acute at-home healthcare treatments their staffers provide complement those delivered by hospitals. “It is always better to heal and recover at home versus in a hospital or rehab. We can’t eliminate hospitals,” says Sokolsky.
Even when home health care is not acute, Sokolsky argues it is still irreplaceable. “You need your personal care taken care of to be prepped for acute care,” she says.
The Ohio State model
To qualify for Ohio State’s Hospital at Home program, a patient must meet several guidelines set by CMS. For example, the patient must present at the ER or be in-patient to complete their hospital stay at home, says Thariani.
The CMS waiver requires the at-home patient to:
- Originate either at a hospital’s ER or as an in-patient released early for home medical care
- Undergo a daily provider visit with a physician (which can occur remotely) or with an advance practice provider or nurse practitioner in person
- Receive two daily visits completed in person by an RN or possibly an emergency medical technician
Moreover, the CMS waiver requires the overseeing entity to provide patients access to care providers 24/7/365.
What’s next?
If evidence of lowered health costs, improved patient satisfaction, and increased productivity are the outcomes of Ohio State’s Hospital at Home program, Thariani predicts a bright future for it. However, if the CMS waiver is not extended beyond 2024, trouble could lie ahead for these programs, he says.
“Once we prove it does (succeed in those areas), lots of things will fall into place. (Home healthcare) just becomes another part of mainstream healthcare. It is incumbent on us to fine-tune the model and produce evidence of positive outcomes, and lowered costs,” he says.
The cellular-enabled tablet provided to each Hospital at Home patient also enables medical caregivers to glean a more accurate glimpse into a patient’s home life as they recuperate. For example, Tharani says, “We can lay eyes on a patient’s constraints on living conditions, access to healthy food, if their medications are organized and even if their bed is safe. Hospital at Home is truly personalizing medical care to a patient’s individual needs.”
