Health care consumerism: Hospital-at-home

The average length of stay, or ALOS, is the average number of days patients spend in an acute care hospital. The annual ALOS in the U.S. varies between 4.5 to 6.5 days, depending on where you look or over what period. It might not seem like much time, but if you find yourself away from the comfort of your bed and away from your loved ones, it could feel quite disagreeable.

Hospital-at-home is a growing concept that, according to the American Hospital Association, “enables some patients who need acute-level care to receive care in their homes, rather than in a hospital.” In March 2020, the Centers for Medicare & Medicaid Services (CMS) created the Acute Hospital Care at Home program, initially called the Hospitals Without Walls program, to increase hospital capacity during the COVID-19 pandemic.

Many health systems are exploring hospital-at-home options as potential solutions to address the shrinking workforce, rising cost of care, and reduced revenue for hospitals. Moreover, research has shown that hospital-at-home programs can successfully improve care outcomes, enhance patient experience, and reduce costs. Amidst the pandemic, approximately 100 health systems capitalized on a waiver from CMS to provide acute care services in the home setting.

The topic of hospital-at-home often sparks passionate debate about its windfall and challenges. Hospital service providers are expressly concerned about whether they can deliver the same quality of care in a patient’s home as in the hospital. In-hospital medical complications are one of the hospitals’ pain points. Studies show that in-hospital medical complications were associated with longer length of stay. According to an article published in the New England Journal of Medicine, “Nearly 1 in 4 patients who are admitted to hospitals in the U.S. will experience harm.”

Of course, not all patients are appropriate candidates for a hospital-at-home program. Studies have shown that providing hospital-level care in the home for patients with moderate to high acuity levels can improve health outcomes for certain types of patients.

Technology that identifies and classifies each individual patient into a single, clinically defined, severity-adjusted, mutually exclusive category could be an excellent tool for payers or providers interested in implementing or advancing a hospital-at-home program. Providers and payers can use technology to identify the best candidates for an effective hospital-at-home program that provides better quality of care, patient experience and even some financial benefits.

Some population classification systems collect ICD-10 Z codes which are social determinants of health (SDoH) indicators. Z codes - when captured - are embedded in claims and represent information related to a patient’s socioeconomic situation, including education and literacy, employment, occupational risks, transportation, housing, lack of adequate food or water, or stigma and discrimination.

It is evident that addressing SDoH is critical to improving health care. A hospital-at-home program could be a great avenue to address SDoH as it allows care to be provided to people in their homes. Providing care at home permits easier and better identification and reporting of social issues impacting an individual’s health care than inpatient hospitals can.

Finally, as we observe the increasing shift of inpatient services to outpatient care, we could expect a rise in hospital-at-home services. Grouping software could help address hospital-at-home quality of care concerns. 3M AM-PPCs retrospectively identify potentially preventable complications resulting from ambulatory procedures. The methodology could provide insight into quality improvement opportunities and actionable data that providers or payers can exploit.

Hospital-at-home is part of the growing health care consumerism trend that providers and payors must pay attention to.

Flora Coan, regional manager at Solventum specializing in business development with government agencies.