'If you’re getting better sleep, you’re healing better': Providers expand hospital-at-home programs
Last summer, Ron Wiese had a second-degree burn on his foot. He called DispatchHealth, an urgent care provider that does house calls. The wound was infected, and Ron needed intravenous antibiotics — the kind of thing you’d usually only be able to get in a hospital. But instead of directing him to a brick-and-mortar facility, DispatchHealth offered to set up hospital-level care for Ron at home. It was a new program. Ron was actually their first hospital-at-home patient. But he said he didn’t hesitate.
“You ever been in the hospital?” Ron said with a laugh. “There’s your answer. This is a lot better, right here.”
Ron lives in a north Phoenix retirement community with his wife, Dolores. They don’t drive and they worried if Ron went to a hospital, it would be hard for Dolores to visit. DispatchHealth’s new program allowed Ron to get the care he needed from his living room recliner, with Dolores by his side. A medical team came twice a day, then followed up for several weeks by phone when his treatment was over.
A few months later, it was Dolores who needed hospitalization. The couple was so pleased with Ron’s experience, they chose the at-home model again.
“I like to be active. And to be tied down in bed in a hospital? No. I’ll take this any day,” Dolores said.
At-home programs can’t provide surgery or ICU-level care. But DispatchHealth and dozens of other providers nationwide say technology is good enough these days that X-rays, blood work and many treatments for non-life-threatening conditions can now easily be done on-the-go. And as the pandemic continues to strain the U.S. health care system, a growing number of providers in Arizona and across the country are offering patients the chance to be hospitalized at home. Patients say it’s more comfortable. And medical experts say it can improve health outcomes while lowering costs.
“We get to see what your home situations are like and help figure out what’s the best way to treat you, versus in the hospital, we treat you there and send you home and we don’t know what’s going on afterwards,” said Dr. Vinay Shah, Dolores’ physician.
Shah visited the Wieses' apartment with two nurses and a pair of rolling suitcases filled with medical supplies. Shah said at first, he was skeptical about practicing outside of a medical facility. But now, he’s convinced he can actually offer patients more complete care this way. His colleagues on the mobile medical team agree.
“If you’re getting better sleep, you’re healing better. If you’re eating better, you’re healing better,” said nurse practitioner Kristen Cox. “So being at home, not only is it comfortable for you, but it tells us as providers that you’re getting better.”
That’s not just anecdotal evidence. A 2018 study in the Journal of General Internal Medicine found patients hospitalized at home had better outcomes and ended up getting readmitted less frequently. And even though doctors treated fewer patients each day because they spent longer traveling between visits, at-home programs ended up costing less.
“It’s really hard to build a new tower if you need new beds. It takes years, it takes millions of dollars of capital investment,” said Dr. David Levine with Brigham and Women’s Hospital in Boston, the study’s lead author. “Compare that instead to a home hospital, which basically is just people and some technology.”
Levine said hospitals also perform a lot of routine lab tests every day that rack up costs. And while home programs might just employ a few dispatchers overnight, hospitals are fully staffed round-the-clock.
“In a hospital it’s really hard to adjust your staff,” Levine said. “You just basically have to have a certain number of nurses for a certain number of patients.”
Levine said at-home programs are already the norm in Australia, Spain and Italy. But in the U.S., home hospitalization has faced regulatory barriers.
The pandemic changed things. In 2020, the Centers for Medicare and Medicaid Services announced strategies to ease stress on health care facilities, including more flexibility for home programs.
“Essentially, we went from zero approved hospitals to, a year later, over 185 hospitals all throughout the country approved for this care model,” said Levine. “It is absolutely exploding.”
"Essentially, we went from zero approved hospitals to, a year later, over 185 hospitals all throughout the country approved for this care model."
— Dr. David Levine with Brigham and Women’s Hospital
Arizona’s state Legislature in 2021 also passed a bill to allow more of this type of treatment. DispatchHealth began home hospitalizations in Arizona in August, since then it’s treated just four patients at home. Mayo Clinic began a similar program in Phoenix in September. Dignity Health is also developing a program.
There are still hurdles. Not all insurance providers cover home hospitalization. And the Centers for Medicare and Medicaid waiver was meant to be temporary.
But Levine is optimistic the growth of these programs during the pandemic will demonstrate to regulators and insurers they’re worth expanding long-term. Patients hope so too.
Dolores’ visit with her medical team ends with laughs and hugs. For someone who’s technically hospitalized, it’s clear she’s having a great time.
“It’s the best thing that’s happened since running water,” she said.
They’d prefer not to be hospitalized again, but if they are, Ron and Dolores hope it can be in their living room.