The idea of an extended hospital stay often has been considered a necessary evil of the health care process. After all, you have to be there to get the care you need.
But, do you always have to be?
The concept of delivering hospital-like services to someone in their home — a necessary experiment during the pandemic — is becoming a more common occurrence around the country.
In New Jersey, Hackensack Meridian Health has been leading the effort.
This week, the system announced its intentions to partner with the national leader, Medically Home Group, to expand its Hospital From Home program from three pilot hospitals (Hackensack University Medical Center, Jersey Shore University Medical Center and JFK University Medical Center) to its entire system.
To be clear, the concept does not work for all conditions or all patients (more on that later), but it has been successful enough since the pilot began in 2022 to expand its reach.
CEO Bob Garrett, who has helped the system continually introduce next-generation care options, said the system is thrilled to be able to offer Hospital From Home.
“This type of program, where acute care services are rendered within the home, is really part of the future of health care,” he said. “That’s the way we’re looking at it.
“I think people want to receive as much care as possible either close to home, or actually in their home. I think COVID certainly taught us that in a very big way.”
Home hospital care is one of the fastest-growing modes of care, delivered through a hybrid model of virtual and in-person visits.
Through Hospital From Home, patients are monitored virtually through a clinically integrated, physician-led virtual command center, which operates 24 hours a day to ensure seamless patient care alongside in-person nurse visits.
Services and treatments include IV antibiotics, infusions, medication management, laboratory services, physical, occupational, speech and respiratory therapy and imaging in a patient’s home. Meals and nutritional consultations are also available.
The program is growing nationwide.
Officials from Medically Home said more than 40,000 patients have accessed the program in the past five years. And they have done so while being treated in some of the top health care facilities in the country, including the Cleveland Clinic, Mayo Clinic and Kaiser Permanente.
So, how does it work?
We know you’ve got questions. The following Q&A is curated from interviews with HMH’s Garrett and Patrick Young (president of population health) and Medically Home’s Rami Karjian (CEO) and Raphael Rakowski (co-founder and executive chairman):
Q: What type of patients are a fit for the program?
A: The short answer: Patients who are sick enough to be in the hospital for several nights, but not so sick that you’re going to be in the ICU.
There are strict guidelines on how patients are selected — and it’s not solely about the care they are receiving. Do they have family support at home? Do they have the proper Wi-Fi capabilities that allow them to be tethered to the hospital support team? All of those issues matter.
Q: When does the selection process for the program begin?
A: When the program started, it was during the middle of the hospital stay. Think of it as a way a hospital could allow patients to go home a few days early. Now, the attempt is to identify candidates before they are admitted — something that has obvious benefits to the overwhelmed ER departments.
Q: How much does it benefit patients?
A: An incredible amount. In addition to lowering risk of infections or any other complications that could come in a hospital, there is huge wellness component to being in your own home — and able to move around, as opposed to be stuck in one bed in one room for days.
Q: What is the concern about having something go wrong and not having a physician or nurse right there?
A: The command center obviously is monitored 24-7, with the capability of dispatching medical personnel at a moment’s notice. This concern — while obviously high at the beginning of the program — has not proven to be an issue of any kind.
Q: How has it been working at HMH?
A: Better than expected. The program, which treated approximately 100 patients during the pilot program, has cared for 100 additional patients since it was expanded in April. By the end of the year, HMH officials said they hope to be caring for 15 to 18 patients a day.
Q: Talk about the rollout: How long until this comes to an HMH facility near me?
A: HMH is going hospital by hospital. And it takes about six months to roll out the program. We educate the staff, making sure they understand the processes and the protocols. It’s key to building collaboration at the team level — from the nursing staff, the clinical staff and the physicians — because they need to build up all the redundant services.
When a patient needs a service, it can’t be, ‘We can’t get there, you need to have multiple services available 24/7 to take care of that patient when there’s an issue.’”
Q: Change is never easy. Let’s talk resistance. Has there been any issue around liability?
A: There obviously used to be when we started. It was the first question asked then, but it isn’t now: Having treated 40,000 patients — and doing so with a great deal of reporting on outcomes around the measure of success — has made that a non-issue. And the Congressional Budget Office has said this is a budget-neutral program.
Q: Has there been resistance among the health care professionals?
A: Like anything else, there’s some skepticism when you try something know. That’s why there’s an education process. But, this question can be answered in three ways:
- The real-life experience is probably the best representative of the program. People have had a great experience with it. That’s why we’re starting to see the volumes continue to rise at a much faster rate than we actually anticipated.
- Quite candidly, if the physicians weren’t behind it, we wouldn’t be so successful, because they really are the engine that makes us really work.
- When we asked health care providers what type of care they would want to give their loved ones, this is the type of program they describe.
Q: Last question: We know this is expanding at HMH. Do you think other New Jersey systems will adopt this idea?
A: Absolutely. Some already have reached out to get more information on how this works.
