Hospital-in-the-Home Shows Promise for Reducing Acute Care Costs; Medical Laboratories Face Uncertainties Concerning Expanding Services to In-Home Environments in Support of Care Providers
Despite logistics and test volume concerns for laboratories, hospital-in-the-home services promise to reduce cost and improve quality of care for patients who might be negatively impacted by the noise, stress, and germs of busy hospitals
In April, The Washington Post highlighted the plight of 71-year-old Phyllis Petruzzelli—a patient with a weakened immune system suffering from pneumonia. Instead of admitting her into a noisy ward and exposing her to other germs and infection vectors, doctors at Brigham and Women’s Faulkner Hospital in Boston chose a different approach. They treated her in her home with a remote monitoring patch and in-home visits. Three days later, she was well and referred to her primary care provider for follow-up.
This is an example of the hospital-in-the-home model of clinical care. It is not a new concept and is being developed in a number of countries. In the United States, managers at medical laboratories, hospitals, and integrated health systems will want to stay informed about the ongoing efforts to use the hospital-in-the-home method as a way to improve patient care while lowering the overall cost of a healthcare encounter. One reason is that patients receiving care in their homes will need to be serviced by clinical laboratories.
David Levine, MD, Clinician-Investigator at Brigham and Women’s Hospital, told The Washington Post that despite initial reservations from staff, their testing of hospital-at-home care has been positive. “[Staff] very quickly realize that this is really what patients want and it’s really good care,” he stated.
Hospital-in-the-Home Costs Less, Better Care
Levine is lead author of a study published in the Journal of General Internal Medicine that compared the costs, quality, safety, and patient experience of 20 adult individuals admitted to emergency departments for an infection, exacerbation of heart failure, chronic obstructive pulmonary disease (COPD), or asthma.
“Median direct cost for the acute care plus 30-day post-discharge period for home patients was 67% (IQR, 77%; p < 0.01) lower,” the study authors note, “with trends toward less use of home-care services (22% vs. 55%; p = 0.08) and fewer readmissions (11% vs. 36%; p = 0.32). Patient experience was similar in both groups.”
Though authors acknowledged the need for a larger trial to create definitive results, they concluded that home-hospitalization resulted in reduced cost while allowing improved physical activity.
Hospitals caring for patients in their homes is not a new concept. In 2012, Dark Daily reported on a similar trial involving 323 patients across a year at Presbyterian Healthcare Services in Albuquerque, New Mexico. The study found patients of their hospital-based home care (HBHC) program achieved savings of 19% when compared to costs of similar hospital acute care patients.
And a 2011 study conducted by Deloitte Access Economics found that hospital-in-the-home (HITH) care costs an average of 22% less than hospital care for a range of common conditions and uncomplicated diagnosis. (See Dark Daily, “Australia’s ‘Hospital in the Home’ Care Model Demonstrates Major Cost Savings and Comparable Patient Outcomes,” December 5, 2011.)
Hospital-in-the-Home Care Impacts Pathology Groups and Medical Laboratories
One reason for the reduced costs should concern medical laboratories and other service providers—less diagnostic tests ordered. “During the care episode, home patients had fewer laboratory orders (median per admission: six vs. 19; p < 0.01) and less often received consultations (0% vs. 27%; p = 0.04),” noted the authors of the Brigham and Women’s Hospital study.
Another complication of HITH for clinical laboratories is the patient’s location. When tests are required, clinical laboratory personnel must collect samples in patients’ homes. This could prove a logistical challenge for both independent laboratories and hospital-based labs. Adding overhead for transportation and collection to an already shrinking volume of tests could negatively impact laboratory workflow and revenues alike.
Nevertheless, though HITH is still in its early stages, studies continue to show positive results. The biggest hurdle to adoption of HITH is convincing payers to cover it. Should providers find a way to convince payers to support the new approach, rapid growth of HITH programs is likely.
As more lab-on-a-chip, lab-on-a-fiber, and similar point-of-care diagnostic testing technologies mature and integrate with telehealth solutions and electronic health record (EHR) systems, they also could combine with HITH trends to further impact volumes and margins for clinical laboratories of all sizes.
Healthcare delivery is evolving, and clinical laboratories and pathology groups must remain flexible and support these advances. In adapting to changes and providing flexible services—such as remote collection in HITH care episodes—laboratories can reinforce their value in today’s modern healthcare market and work to compensate for changes in how diagnostic tests and lab results are both utilized and delivered.