A deep dive into hospital at home models with remote patient monitoring — 4 takeaways

While the hospital at home is now receiving a great deal of attention, due in part to COVID-19, "the model has been in existence for quite some time," Doug Lang, VP of client growth at Health Recovery Solutions, said. "This isn't a novel idea; it is a well-proven model." The hospital at home has been used in other countries for years and hospitals across many states are exploring the concept.

During a session sponsored by HRS at Becker's The Shift to Digital: Telehealth, Home Health & Virtual Care virtual event, Mr. Lang described key elements of the hospital at home.

Four key takeaways:


  1. The hospital at home meets multiple goals. Six goals of the hospital at home programs are: 1) reducing length of stay; 2) meeting patient demands to be cared for at home; 3) decreasing the total cost of care; 4) differentiating in a competitive marketplace; 5) maximizing hospital capacity and 6) creating additional revenue.

    Mr. Lang emphasized that health system leaders must "understand your program goals and make sure those goals align with your reasons for getting into the hospital at home." The hospital at home requires strong leadership and a clear vision to overcome resistance to change.

  2. The most common hospital at home models are emergency department diversion and early discharge. When considering the hospital at home, healthcare leaders frequently ask, "Where do we start?" HRS sees the most common approaches as:

    • ED diversion. While ED diversion is appealing, it presents challenges because it requires a redesign of the entire process and creation of new workflows.
    • Early discharge. In contrast, early discharge is "easier to start since the patient is already in the hospital and the workflows are similar," Mr. Lang explained. The patient can be educated in the hospital prior to discharge.

    Regardless of the model, "you must create a single point of access and a clear process" for unambiguous communications and effective handoffs, Mr. Lang said.

  3. Numerous conditions can be treated through the hospital at home. More than 60 conditions can be treated in the home, such as congestive heart failure, chronic obstructive pulmonary disease, pneumonia and asthma. Most programs start by treating less acute conditions, such as cellulitis. But healthcare leaders may determine that these conditions aren't driving their goals, so they shift to CHF and COPD. "A good place to start might be a less acute patient population," Mr. Lang said. "However, you want to make sure this is having an impact across the organization."

    Clear patient selection criteria is vital. Criteria include the clinical condition, insurance carrier and geographic proximity. Exclusion criteria may include social conditions such as caregiver support. 

  4. Remote patient monitoring plays a key role in operationalizing the hospital at home. This delivery model relies on the coordination of many resources, such as transportation, food delivery and pharmacy. Providers look to leverage existing resources, like an existing home health agency.

    RPM helps enable — and go beyond — CMS requirements for acute care at home that are the baseline for operations. These features include multiple daily patient vitals, a video platform for remote visits and an emergency response system able to be at the patient's home within 30 minutes.

While the hospital at home presents exciting possibilities, there are multiple factors that must be considered including the program's goals, model, leadership support and patients to be included/excluded.

To view the session, click here.

To learn more about the event, click here.



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