News, Analysis, Trends, Management Innovations for
Clinical Laboratories and Pathology Groups

Hosted by Robert Michel

News, Analysis, Trends, Management Innovations for
Clinical Laboratories and Pathology Groups

Hosted by Robert Michel
Sign In

Orlando Health’s New Hospital-in-the-Home Program Brings Quality Healthcare to Patients in the Comfort of their Homes

New federal funds likely to spark additional growth in hospital-at-home programs across the US while creating need for clinical laboratories to serve these homebound patients

In one of the latest examples of health systems’ providing acute care to patients outside of traditional hospital settings, Orlando Health announced its launch of the Orlando Health Hospital Care at Home program serving central Florida.

Clinical laboratory testing is included in the program, which is currently being offered to Medicare and Medicaid patients of Orlando Regional Medical Center and Orlando Health South Seminole Hospital.

According to an Orlando Health press release, “The Orlando Health program is the first in Central Florida to be approved for Medicare and Medicaid patients, with future plans to expand the service for patients with private insurance and at other Orlando Health locations. It is an extension of a federal initiative created during the height of the COVID-19 pandemic to increase hospital capacity and maximize resources.”

Orlando Health is a not-for-profit healthcare system with 3,200 beds at 23 hospitals and emergency departments. It is the fourth largest employer in Central Florida with 4,500 physicians and 23,000 employees. Its Hospital Care at Home program serves patients who meet clinical criteria with 24/7 telehealth remote monitoring and virtual care from the Orlando Health Patient Care Hub. In-person nursing visits are also offered daily, according to Orlando Health.

Linda Fitzpatrick

“Orlando Health wanted to be able to provide a different level of care for its patients and give them a different opportunity to be cared for other than the brick-and-mortar of the hospital,” Linda Fitzpatrick (above), Assistant Vice President for Advanced Care at Orlando Health told Health News Florida. “We’ll have decreased infectious rates in their homes, decreased exposures. It is a healthier and happier place to be in order to heal.” Clinical laboratories in the Orlando area will have the opportunity to serve healthcare providers diagnosing patients in non-traditional healthcare settings. (Photo copyright: Orlando Sentinel.)

Lowering Costs and Avoiding In-hospital Infections, Medical Errors

Treating patients at home, even after inpatient visits, can save them money. At the same time, patients are more comfortable in their own homes and that contributes to faster recoveries.

“[We’ll be able to measure] heart rate, respiration, temperature, and blood pressure. We’ll also do video conferencing from that location with the patient. We’ll have nurses going to the patient’s home at least twice a day,” interventional cardiologist Rajesh Arvind Shah, MD, Senior Medical Director of Hospital Care at Home, Orlando Health, told Health News Florida.

Orlando Health patients can be safely treated in their homes for many conditions including:

According to the American Hospital Association (AHA), “many are seeing the hospital-at-home model as a promising approach to improve value. … This care delivery model has been shown to reduce costs, improve outcomes, and enhance the patient experience. In November 2020, the Centers for Medicare and Medicaid Services launched the Acute Hospital Care at Home program to provide hospitals expanded flexibility to care for patients in their homes.”

Hospital-in-the-Home (HITH) is considered by many experts to be safer for patients, as they are not exposed to nosocomial (hospital-acquired) infections, falls, and medical errors. In its landmark “To Err is Human” report of 1999, the Institute of Medicine (IOM) estimated that medical errors killed as many as 98,000 patients in hospitals annually.

Dark Daily has often reported on HITH programs.

In “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,” we reported how doctors at Brigham and Women’s Faulkner Hospital in Boston had chosen to treat a 71-year-old pneumonia patient with a weakened immune system in her home rather than admitting her into the hospital and risking exposing her to germs and infection vectors. The patient recovered fully within days.

In “Two US Studies Show Home-based Hospital Care Lowers Costs while Improving Outcomes and Patient Satisfaction,” Dark Daily reported on a year-long proof-of-concept trial involving 323 patients at Presbyterian Healthcare Services in Albuquerque, New Mexico. The study found patients of their hospital-based home care program achieved savings of 19% when compared to costs of similar hospital acute care patients.

And in “Australia’s Hospital-in-the-Home Care Model Demonstrates Major Cost Savings and Comparable Patient Outcomes,” we predicted that wider adoption of that country’s HITH model of patient care would directly affect pathologists and clinical laboratory managers who worked in Australia’s hospital laboratories. Having more HITH patients would increase the need to collect specimens in patient’s homes and transport them to a local clinical laboratory for testing, and, because they are central to the communities they serve, hospital-based medical laboratories would be well-positioned to provide this diagnostic testing.

New Federal Funds for HITH Programs

One recent impetus to create new HITH programs was the passing of the Consolidated Appropriations Act, 2023 (HR 2617). The federal bill includes two-year extensions of the telehealth waivers and Acute Hospital Care at Home (AHCaH) individual waiver that got started during the COVID-19 pandemic.

As of March 20, the federal Centers for Medicare and Medicaid Services (CMS) listed 123 healthcare systems and 277 hospitals in 37 states that had been approved to use the AHCaH wavier.

Now that federal funding for AHCaH waivers has been extended, more healthcare providers will likely start or expand existing HITH programs.

“I think [the renewed funding] is going to allow for additional programs to come online,” Stephen Parodi, MD, Executive Vice President External Affairs, Communications, and Brand, Permanente Federation; and Associate Executive Director, Permanente Medical Group, told Home Health Care News.

“For the next two years, there’s going to be a regulatory framework and approval for being able to move forward. It allows for the collection of more data, more information on quality, safety, and efficiency of these existing programs,” he added. Parodi also oversees Kaiser Permanente’s Care at Home program.

Labs without Walls

Clinical laboratories can play a major role in supporting HITH patients who require timely medical test results to manage health conditions and hospital recovery. Lab leaders may want to reach out to colleagues who are planning or expanding HITH programs now that federal funding has been renewed. 

—Donna Marie Pocius

Related Information:

Where Hospital-at-Home Programs Go Next

Orlando Health Launches Hospital Care at Home Program

Some of Orlando Health’s Patients Can Now Receive Hospital Care at Home

How AI, Digital Health, and Home-Based Services Can Help Prevent Hospital Readmission

CMS: Acute Hospital Care at Home Individual Waiver Only (not a blanket waiver)

CMS: Approved Facilities/Systems for Acute Hospital Care at Home

To Err is Human: Building a Safer Health System

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

Two US Studies Show Home-based Hospital Care Lowers Costs while Improving Outcomes and Patient Satisfaction

Australia’s ‘Hospital in the Home’ Care Model Demonstrates Major Cost Savings and Comparable Patient Outcomes

Ranking the Nation’s 20 Largest Doctor Groups Reveals Surprises

Nine of the 10 largest medical groups are located on the East and West coasts

When it comes to the list of the 20 largest physicians groups in the United States, Kaiser Permanente is at the top. With 7,000 physicians, Permanente Medical Group in Northern California is the nation’s largest. Number two is Southern California Permanente Medical Group, based in Pasadena, California. At number 20 is the University of Indiana School of Medicine with 1,481 physicians.

This list was prepared by the Medical Group Management Association  (MGMA) and published in Modern Healthcare . One interesting fact is that all but one of the 10 largest medical practices are located on the east or west coast. Overall, six of the top 20 medical groups are located in the Midwest, one in Texas, and the rest in coastal cities.

There are 51, 280 physicians practicing in the nation’s 20 largest medical groups. This represents about 6.4% of the 800,000 physicians licensed in the United States – P. Kirk

20 Largest Medical Groups:  

RANK – GROUP # OF DOCTORS CITY
1. Permanente Medical Group 7,000 Oakland
2. Southern California Permanente Medical Group 6,400 Pasadena
3. Bellevue Hospital Center 4,000 New York
4. University of Medicine & Dentistry of Newark 2,816 Newark
5. Albert Einstein College of Medicine of Yeshiva Univ. 2,775 New York
6. University of Pittsburgh Medical Center 2,700 Pittsburgh
7. Johns Hopkins University 2,694 Baltimore
8. Columbia University Medical Center 2,189 New York
9. David Geffen School of Medicine at UCLA 2,000 Los Angeles
10. Mayo Clinic 1,995 Rochester
11. University of Washington Medicine 1,830 Seattle
12. Northeastern Ohio Univ. Colleges of Med & Pharmacy 1,800 Rootstown
13. University of Michigan Health System 1,746 Ann Arbor
14. Massachusetts General Hospital 1,746 Boston
15. University of Pennsylvania Medicine 1,700 Philadelphia
16. Baylor College of Medicine 1,607 Houston
17. University of Illinois Medical Center at Chicago 1,604 Chicago
18. Northwestern Memorial Hospital 1,600 Chicago
19. Winthrop University Hospital 1,525 Mineola
20. Indiana University School of Medicine 1,481 Indianapolis
Total all physicians from all groups: 51,208  
Source: MGMA, Englewood, Colorado    
     

Related Information:

Largest medical group practices

Is Integration in Large Medical Groups Associated With Quality? (PDF)

Benefits of and Barriers to Large Medical Group Practice in the United States (PDF)

;