Hospital at Home Program Rises to Coronavirus Pandemic Challenge

The research article features several key data points.

• Over the 95-day study period, the Brigham Health home hospital program cared for 65 acutely ill patients, which amounted to 419 bed-days.
• During the study period, the home hospital program was staffed daily by one physician, one or two nurses, and one mobile integrated health paramedic.
• Most (59%) home hospital patients were treated for infection followed by heart failure exacerbation (22%).
• Most (65%) home hospital patients were discharged without services, 12.3% were readmitted within 30 days, and 13.8% presented to the emergency department within 30 days.
• Over the 95-day study period, a field hospital established in Boston cared for 394 patients. The field hospital was staffed by 124 clinicians and 331 nurses. The cost of operating the field hospital was $29.8 million, which amounted to more than $75,000 per patient.

Interpreting the data

The lead author of the research article told HealthLeaders that the Brigham Health home hospital program made a significant contribution to acute-care capacity during the COVID-19 patient surge.

“During that first coronavirus surge in Boston, bed capacity was very challenging. Every single bed that we could get for patients who were seriously ill and needed to be in a hospital was a big deal. If you had told me that you could have created a model that could take five patients out of the hospital, I would have said, ‘Let’s look at that.’ So, the fact that we were able to take care of 65 patients was impressive and impactful for the hospital, especially during those surge conditions,” said David Levine, MD, MPH, MA, medical director for strategy and innovation at the home hospital program.

The cost of caring for patients in the home hospital program was a small fraction of the cost of caring for patients in the field hospital, he said.

“We did a randomized control trial that was published in Annals of Internal Medicine that showed that home hospital care costs about 38% less than traditional hospital care. Obviously, the cost of home hospital care is going to be way shy of the $75,000 per patient number at the field hospital. Typical hospital care costs about $15,000 per patient and home hospital care is about 38% less of that figure,” Levine said.

Brigham Health’s home hospital program should be viewed as a supplementary response to Boston’s first COVID-19 patient surge, he said. “There was a different patient profile at the field hospital compared to home hospital. It is important to see home hospital as a complementary opportunity for hospital systems when thinking about responding to a pandemic. We should not get rid of field hospitals—but we need to think about complementary strategies for taking care of patients such as home hospital.”

Future prospects for hospital at home programs

Levine has an expansive vision for the future of hospital at home programs.

“I am excited about the future of home hospital. If my vision comes true, hospital at home will be the way that we care for many acutely ill patients in the future and being in a traditional hospital bed will the exception as opposed to the rule. We are going to be able to expand home hospital with novel and creative care pathways and new technologies. We should be able to get this new care model to every person in the country irrespective of where they live and be able to get them the care that they need in their home,” he said.

Reimbursement has been a major obstacle for hospital at home programs in the United States. That barrier was dramatically eased in November 2020, when the Centers for Medicare & Medicaid Services implemented the Acute Hospital Care At Home waiver. The waiver makes home hospital services eligible for Medicare fee-for-service reimbursement during the coronavirus public health emergency.

“It is exciting to look at the adoption curve since the CMS waiver. We went from about six programs to 145 programs in six months during a pandemic. It is a feat of early adoption,” Levine said.