AHN offers at-home recovery for some patients
Company encouraged by initiative’s findings
Moving medical care out of the hospital — a decadeslong trend — got a boost in a recent Medicare decision to pay for expanded services that are provided in the patient’s home.
The Centers for Medicare and Medicaid Services in November introduced the Acute Hospital Care at Home initiative, which allows Medicare fee-for-service payments for care that has historically been rendered in a hospital. Allegheny Health Network was out ahead of
CMS’ decision by a year when it launched its Home Recovery Care program in 2019, a 30-day program, in cooperation with AHN corporate parent Highmark Blue Cross Blue Shield.
The result: Carefully screened patients may go home to heal under the guidance of a doctor. In March, AHN’s program was expanded to include 60-day episodes of rehabilitation and related care that otherwise would be provided in a nursing home.
AHN’s partner in the program is Nashville-based Contessa Health, a 6- year- old home- based care startup, which operates similar programs with health systems around the country. Among the conditions that can be treated at home include asthma, congestive heart failure, pneumonia and urinary tract infections.
For 79-year-old Plum resident Anthony Santek, who was receiving intravenous antibiotics at AHN’s Forbes Regional Hospital in
November, the choice was a “nobrainer.”
“I was able to go home with the IV still in my arm,” said Mr. Santek, a retired hydraulics engineer, who said the alternative was an extra two days in the hospital for treatment of diverticulitis. “It was ideal.”
The patient’s pulse, heart rhythm and other vital signs are monitored remotely while a visiting nurse tracks the patient’s progress. A recovery care coordinator makes sure prescriptions get filled and the patient schedules a followup visit with a specialist within a week of getting home.
In addition to Forbes, Recovery at Home is offered at AHN’s
“It was nice to come home to eat your own food, sleep in your own bed. It sure made it easier.” — Anthony Santek, Plum
Allegheny General and Jefferson hospitals.
Acute care medical services provided in the home is an idea gaining traction because it’s what patients prefer and it reduces health care costs. For patients covered by a Medicare Advantage health plan, for example, shifting acute care services to the home can save 15% over the cost of a hospital stay; for commercially insured patients, the savings are 38%, said Mark Montoney, chief medical officer at Contessa.
“We don’t have the fixed cost structure” of the hospital, Dr. Montoney said. “Patients really, really like this option. The results are pretty compelling.”
One hitch: CMS’ waiver that allows acute hospital care to be provided in the home only lasts as long as the COVID-19 public health emergency that was declared by the federal government. There are no guarantees the waiver will continue after the pandemic is over, but Contessa’s Dr. Montoney said he was hopeful it would, partly because of the good outcomes from the arrangement.
An average day in a Pennsylvania hospital costs $ 2,581, according to the Kaiser Family Foundation, so the savings from recovering at home can add up quickly. And patients who go home for care are readmitted to the hospital at a rate up to 44% lower than those who receive care in a hospital, while such things as falls, bed sores and other complications of a hospital stay were virtually zero in the patients who went home in the AHN program.
A 2018 study of a hospitalat-home program in Boston found even bigger savings: Median savings for an acute care episode were 52%, not including fewer requests for medical consultations and lab tests.
“It’s a way to re-imagine the way you can provide care and lower the cost,” said Christina Weir Ripley, vice president of clinical transformation at AHN corporate parent Highmark Health.
The concept is taking off elsewhere, according to research by investment adviser Frost & Sullivan of San Antonio, Texas. Six health systems offered recoveringat-home care in November, which increased eightfold to 48 centers in March.
Moreover, “remote monitoring and telehealth technologies are expected to witness a high growth rate of 35% to 40% with the major push coming from the home care segment,” Frost & Sullivan research analyst Kaustubh Suresh Savant wrote.
For Mr. Santek, who enjoys tending his lawn and flower garden and the 1973 MGD roadster sports car he restored, he appreciated the ease of the arrangement.
“It was nice to come home to eat your own food, sleep in your own bed,” Mr. Santek said. “It sure made it easier.”