Upstate launches Hospital at Home program
Upstate University Hospital has launched a new initiative that will allow patients to receive medical care in the comfort of their own home.
Upstate Hospital at Home allows for some patients who need inpatient care but are well enough to be home to safely finish their treatment in their own home. These patients receive two in-person nurse visits and one in-person or telemedicine visit from a provider daily, delivery of all necessary equipment, supplies and prescriptions, and 24/7 remote monitoring.
So far, seven patients have been admitted to the program.
“It makes sense to be able to extend care into the home setting,” said Nancy Daoust, chief ambulatory officer. “That’s where patients want to be.”
Programs like this have been in development across the country over the past several years and require approval from the Center for Medicare and Medicaid (CMS) to start them. In the past, the application process was lengthy and the requirements for nursing care were high: a nurse had to be at the home 24/7.
But the Covid-19 pandemic changed everything. Hospitals struggled to meet the demands of the patient surge and the federal government declared a Public Health Emergency. In conjunction, CMS issued a waiver approval for its Hospital Without Walls initiative. The waiver streamlined the process to apply and reduced the nursing requirement to two daily visits.
Daoust said these changes helped pave the way for Upstate to begin developing its program. A team was assembled in May of 2021 and Upstate’s program was approved by August. From there Daoust said, the program build began in earnest with policies and protocols development, vendor contracts, and education for staff involved. The systems were tested to ensure the correct pathways were followed.
“And since the CMS waiver is new, it took some time to be approved by NYS Department of Health as we worked to explain the model and provide sufficient documentation which demonstrated our ability to do this safely,” she said. “There has been a tremendous amount of program build that’s happening in the background,” Daoust said.
Only a specific subset of patients and conditions are eligible for the Upstate program.
It is only available to Medicare FFS (Fee for Service) patients who live in Onondaga County, and eligible conditions include pneumonia, COPD, cellulitis, cystitis and congestive heart failure. The home must be deemed safe and accessible. Patients can enter the program from an in-patient stay once they are deemed appropriate to continue their care at home and plans are underway to admit to home directly from the emergency department. Upstate is partnering with Nascentia to provide the nursing care.
Daoust said a sophisticated algorithm was created to identify the multiple process steps which occur to transfer a patient into the Hospital at Home program. Once a patient is identified (captured from a daily report with inclusion criteria) the nurse case manager and attending physician meet with the patient and explain the program to inquire if they are interested. The transition from an inpatient floor to the home setting requires significant collaboration between the UH H@H care team, Nascentia, EMS transport service, and others to ensure safe arrival and set up. The transfer process can take up to 24 hours.
Upstate may broaden patient eligibility criteria after assessing the program’s early results.
Research shows that patients who can stay at home have better clinical outcomes. They have fewer hospital readmissions, emergency room visits or need for nursing home care.
“It’s about providing the care to the patient that’s the best setting for them,” Daoust said. “Hospital environments are not always conducive to good sleep, patients are away from their families. Hospitals can raise people’s anxiety levels. They find it much more satisfying to be at home.”
But the CMS waiver that allows Upstate and more than 200 other hospitals in the US to conduct these programs will only exist as long as the Covid-19 Public Health Emergency does. Originally declared in March 2020, the PHE has been extended nine times, and was recently renewed through July 16.
To help secure the future of these programs, bipartisan legislation for the Inpatient Services Modernization Act has been introduced in both the house and the senate. This bill would extend the current waiver flexibilities for two years from the end of the PHE. Neither bill has been voted on yet.
Nevertheless, Daoust said that programs like this are becoming increasingly necessary for Upstate to best serve its patients.
“This is one tool in the toolbox that Upstate is using to try to be that model of what the hospital of the future looks like,” Daoust said. “We know the services and the care that we provide needs to move out of the four walls of the hospital and we need to provide care in different settings. We are growing the ambulatory services and offering more telemedicine and programs such as Upstate Hospital at Home to meet patients where they are.”
Upstate CEO Robert Corona, MD, said that this new program will help the hospital keep up with patient demand.
“Hospital at home is part of our 4 strategies to meet the demand for our services,” Corona said. "We have in-patient care, ambulatory care, virtual care (telehealth) and home care (hospital at home). This is about meeting patients where they are in location and in the health cycle. This reduces our capacity burden/staff shortages. People want to be in their homes, and we have the technology and know-how to provide them with the services they want.”
For more information, visit Hospital at Home.