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Today is the anniversary of @KlayThompson going off on OKC in Game 6 of the WCF. It's also @tradeoffspod drop day. Here's an 11-part thread, one for every 3 Klay made, about our new episode on why hospital-at-home care is seeing a sudden surge in interest. https://tradeoffs.org/2020/05/28/home-sweet-hospital/
1. The idea of bringing hospital-level care into patients’ homes may sound wild, but it’s actually been proven in dozens of RCTs to be safer, cheaper and more effective than inpatient care for some conditions like simple pneumonia, cellulitis and COPD. https://www.acpjournals.org/doi/10.7326/M19-0600
2. Despite decades of evidence behind it, this care model has been stuck largely in limbo, loved by a few academic medical centers but ignored by most of America’s other 6,000+ hospitals. https://www.commonwealthfund.org/publications/newsletter-article/hospital-home-programs-improve-outcomes-lower-costs-face-resistance
3. Three big barriers have slowed hospital-at-home adoption: 1) lack of reimbursement by Medicare 2) hospitals’ complacency with their current business models and 3) skepticism from both docs and patients. #COVID19 is poised to knock down all three. https://jamanetwork.com/channels/health-forum/fullarticle/2765661
4. When it comes to payment, @CMSgov began releasing emergency waivers in March allowing hospitals to deliver care in new settings. The latest guidance, released in May, gave examples of how these waivers can be applied. On Page 10: hospital care at home. https://www.cms.gov/files/document/covid-19-regulations-waivers-enable-health-system-expansion.pdf
5. Health systems say they’d still like more clarity from @CMSgov, but a CMS spokesperson did confirm Medicare will now reimburse hospital care at home under certain conditions. Will that remain true post-COVID? TBD.
6. Next barrier: hospital complacency with current business models. With revenues plummeting, COVID has many executives recognizing their overreliance on brick-and-mortar facilities, what one expert called "the edifice complex," can be a real liability.
7. Companies like @contessahealth @medically_home that help hospitals provide this service (turning a home into a hospital is no small feat) report a huge influx in inbound calls from hospitals after years of little but...crickets. https://www.medicallyhome.com/adventist-healths-hospitalhome-expands-flexible-bed-capacity-during-covid-19/
8. Big systems like @adventisthealth @tuftsmedicalctr have recently signed contracts with hospital-at-home companies. Will others follow? A lot depends on @CMSgov emergency payment rules sticking around and on the last barrier…
9. Skepticism from docs and patients. For decades, the hospital has been seen as the gold standard for care. COVID has certainly shaken that up, with ER visits cratering and heart attacks "vanishing" into thin air. https://www.nytimes.com/2020/04/06/well/live/coronavirus-doctors-hospitals-emergency-care-heart-attack-stroke.html
10. If a vaccine arrives and fear subsides, will patients cool on hospital care at home? Their new embrace of telehealth and their comfort with companies like Airbnb and Uber that provide old services in new settings...are signs that interest may stick. https://www.statnews.com/2020/03/17/telehealth-services-overwhelmed-amid-coronavirus-pandemic/
11. But in the end, as with most COVID-catalyzed trends, it’s still too soon to know if this will last. @kavitapmd told us she’d give hospital-at-home a 25% chance of sticking around in a big way. Sounds slim but it’s a whole lot likelier than the 5% odds she gave it a year ago.
