Health Affairs: N.M. system sees 19% savings with home health
A healthcare system in Albuquerque, N.M., by adapting a home healthcare program, achieved savings of 19 percent over costs for similar inpatients.
Publishing their findings in the June edition of Health Affairs, Lesley Cryer, RN, executive director of the home healthcare division of Presbyterian Healthcare Services (PHS) in Albuquerque, and colleagues noted these savings were predominantly derived from lower average length of stay and use of fewer lab and diagnostics tests compared with similar patients in hospital acute care.
PHS is a private, nonprofit system consisting of eight hospitals who adopted “Hospital at Home” in October 2008, a model developed by investigators at the Johns Hopkins University Schools of Medicine and Public Health, to serve an aging population with increasing prevalence of chronic disease.
The Hopkins group theorized that the hospital is an unsafe environment for many older adults and that most patients do not want to stay in a hospital, the authors wrote. “The [Hopkins] group speculated that these patients would instead do better at home, where providing acute care is far less expensive.”
Hospital at Home was initially open at PHS to Medicare Advantage and Medicaid members covered through Presbyterian Health Plan. The program expanded its coverage in November 2010 to include commercial health plan members through a bundled-payment rate reimbursing for the total care provided.
Nine diagnostics groups were selected based on suitability for at-home care and frequency of acute care admissions: exacerbations of congestive heart failure, chronic obstructive pulmonary disease, community-acquired pneumonia, cellulitis, deep venous thrombosis, pulmonary embolism, complicated urinary tract infection or urosepsis, nausea and vomiting and dehydration.
Between October 2008 and April 2012, 582 Hospital at Home patients were under the care of PHS. “During the measurement period, there were 348 qualified patients who were offered Hospital at Home care,” they wrote. Of these patients, 93 percent opted for care at home rather than the acute care hospital.
Using a comparison group to assess the program’s impact, patients were elderly in both groups, with a majority female and Caucasian, and community-acquired pneumonia was the most common admitting diagnosis. The mean length of Hospital at Home stay was 3.3 days with a median of three days. The mean stay in the comparison group was 4.5 days.
For care provision measures, patients in Hospital at Home received an average of 3.5 physician visits and 6.4 nursing visits per admission, according to the authors. Eight patients (2.5 percent) were transferred to the hospital to complete their admission, mostly because their condition worsened. After-hours and unplanned patient visits because of additional assistance needs totaled fifteen nursing visits and three physician visits.
“Hospital at Home can provide integrated systems with the ability to manage and improve health across the continuum, while accounting for and reducing costs,” the authors concluded. “In response to the favorable results Presbyterian has seen for its Hospital at Home program, it has expanded the qualified patient population by increasing the catchment area, extending the time for accepted referrals, allowing participation from commercial health plan members, and adding more diagnoses to the Hospital at Home repertoire.”
Publishing their findings in the June edition of Health Affairs, Lesley Cryer, RN, executive director of the home healthcare division of Presbyterian Healthcare Services (PHS) in Albuquerque, and colleagues noted these savings were predominantly derived from lower average length of stay and use of fewer lab and diagnostics tests compared with similar patients in hospital acute care.
PHS is a private, nonprofit system consisting of eight hospitals who adopted “Hospital at Home” in October 2008, a model developed by investigators at the Johns Hopkins University Schools of Medicine and Public Health, to serve an aging population with increasing prevalence of chronic disease.
The Hopkins group theorized that the hospital is an unsafe environment for many older adults and that most patients do not want to stay in a hospital, the authors wrote. “The [Hopkins] group speculated that these patients would instead do better at home, where providing acute care is far less expensive.”
Hospital at Home was initially open at PHS to Medicare Advantage and Medicaid members covered through Presbyterian Health Plan. The program expanded its coverage in November 2010 to include commercial health plan members through a bundled-payment rate reimbursing for the total care provided.
Nine diagnostics groups were selected based on suitability for at-home care and frequency of acute care admissions: exacerbations of congestive heart failure, chronic obstructive pulmonary disease, community-acquired pneumonia, cellulitis, deep venous thrombosis, pulmonary embolism, complicated urinary tract infection or urosepsis, nausea and vomiting and dehydration.
Between October 2008 and April 2012, 582 Hospital at Home patients were under the care of PHS. “During the measurement period, there were 348 qualified patients who were offered Hospital at Home care,” they wrote. Of these patients, 93 percent opted for care at home rather than the acute care hospital.
Using a comparison group to assess the program’s impact, patients were elderly in both groups, with a majority female and Caucasian, and community-acquired pneumonia was the most common admitting diagnosis. The mean length of Hospital at Home stay was 3.3 days with a median of three days. The mean stay in the comparison group was 4.5 days.
For care provision measures, patients in Hospital at Home received an average of 3.5 physician visits and 6.4 nursing visits per admission, according to the authors. Eight patients (2.5 percent) were transferred to the hospital to complete their admission, mostly because their condition worsened. After-hours and unplanned patient visits because of additional assistance needs totaled fifteen nursing visits and three physician visits.
“Hospital at Home can provide integrated systems with the ability to manage and improve health across the continuum, while accounting for and reducing costs,” the authors concluded. “In response to the favorable results Presbyterian has seen for its Hospital at Home program, it has expanded the qualified patient population by increasing the catchment area, extending the time for accepted referrals, allowing participation from commercial health plan members, and adding more diagnoses to the Hospital at Home repertoire.”