The Pennsylvania system began offering acute care services at home more than two years ago. Vipul Bhatia of WellSpan talks about the factors in the program’s success.
More health systems have launched hospital-at-home programs during the COVID-19 pandemic, but WellSpan Health began its plans before the arrival of the coronavirus.
In fact, the pandemic forced WellSpan to delay its launch of the home hospital program. WellSpan, based in central Pennsylvania, initially hoped to begin offering acute care services to patients at home in the spring of 2020, but the upheaval of COVID-19 forced a pause until September 2020.
WellSpan planned carefully and reached out to the handful of health systems operating hospital-at-home systems at the time, says Vipul Bhatia, associate chief medical officer of post-acute and continuing care services at WellSpan. WellSpan learned how other systems were doing it and gained valuable insights in providing acute care at home, he tells Chief Healthcare Executive®.
“I think our careful attention to those details, before we even launched, was a key ingredient to our success,” Bhatia says.
WellSpan is seeing good returns from its hospital-at-home program, both in terms of outcomes and patient satisfaction. He says the program has been “very successful.”
“Are they better compared to if they had gotten the same care in the hospital setting? And it turns out that yes, they are,” Bhatia says. “So our ED utilization rate and readmission rate is much better.”
“We routinely conduct patient experience surveys and caregiver experience surveys for everyone that has been through the program. And we are in the high 90s,” he adds. “So very highly satisfied patient population here.”
(Vipul Bhatia of WellSpan talks about the hospital-at-home program in this video. The story continues below.)
More health systems have launched home hospital programs in the COVID-19 pandemic. As of March 20, 277 hospitals in 37 states are running hospital-at-home programs, according to the Centers for Medicare & Medicaid Services.
WellSpan is treating eight to 10 patients at any given time in its hospital-at-home program, Bhatia says. He points out these are all patients receiving acute care at home, where nurses are visiting patients at least twice a day. When patients are done with acute care, they are transferred to remote patient monitoring, typically for about 30 days.
Patients are carefully screened to ensure they can be cared for at home.
“They have to be sick enough to be requiring the hospital-at-home services,” Bhatia says. “But at the same time not too sick, that the care rendered in the home would potentially be unsafe care, and may take the patient down the wrong path in terms of outcomes. So it's the fine, fine balance that we have to do.”
They also don’t want to overuse the program, he says, since it requires nurses to visit patients at least twice a day, and sometimes more often.
“We want to save that precious resource for the patients who truly need it and will benefit from it,” Bhatia says.
WellSpan requires patients to have someone who can be there with them, so patients living alone aren’t eligible for the system’s hospital-at-home program.
WellSpan serves a wide swath of central Pennsylvania, including some rural communities. WellSpan treats patients in rural settings in the hospital-at-home program, but they have to be within 30 minutes of one of the system’s emergency rooms. Bhatia says the system initially tried a 30-mile radius, but for some in rural areas with winding roads, they were an hour from the hospital, so WellSpan adjusted the boundaries for the program.
Some of WellSpan’s area includes Amish communities, who travel by horse and buggy and shun most modern technology. WellSpan offers services to Amish patients, and a few Amish patients have received hospital service at home, and have fared well, Bhatia says.
‘A team effort’
To run a successful hospital-at-home program, health systems must build teams carefully. Clinicians in such programs need to be comfortable working in a patient’s home, but they are providing hospital-level care.
“Any misstep can lead to care not being delivered at the right time for the patients and that could lead to poor outcomes,” Bhatia says. “So when I sit here and talk about the great outcomes we have had, it's not just an action of one individual. It's not just an action of one discipline, like a physician or a nurse practitioner or a nurse. It's a team effort.”
“For any organization to think about launching a program, you have to think of it as recreating the whole team to deliver care in the home setting, with all those tight knit and very tight processes,” he says.
While lauding the efforts of the team, Bhatia also says the fact that patients are in their own home is a big factor in their recovery. Patients are getting better rest, the food they enjoy. and they aren’t in a strange setting.
“I think being in their own familiar environment is a very big factor we often do not recognize,” Bhatia says.
“A lot of times people are confused in the hospital because they don't know where they are,” he says. “And then that aspect is not there in the home because they're intimately aware of where they are. Number two is yes, food is a big thing.”
Patients being treated at home are also less likely to fall than patients in the hospital, Bhatia says.
That home field advantage, so to speak, is “probably one of the top two or top three reasons why we are seeing such success.”
When asked about the financial returns, Bhatia says, “Hospital-at-home programs are not developed to make money, but essentially to do the right thing for the patients.”
At the same time, he points to some financial benefits. In addition to caring for patients in an environment they’d prefer, the hospital-at-home program is adding capacity for sicker patients that need to be in the hospital, Bhatia says.
“Those are 10 patients that are not physically occupying a hospital bed because we are getting them in the home space,” Bhatia says.