Telehealth, RPM Strategies Help Hospitals Bring Acute Care Into the Home

A program at Brigham and Women’s Hospital that uses elements of telehealth and remote patient monitoring helped the Boston-based hospital care for 65 acutely ill patients at home during the height of the coronavirus pandemic, freeing up 419 bed days.

In a report released today, Brigham and Women’s officials say their Home Hospital program reduced stress on the hospital’s inpatient care program by pushing services to the home, while patient care costs were 38 percent less than if those patients had been in the hospital.

While highlighting the value of a connected health program during the pandemic, the report also notes the value of such a program in improving care outcomes, reducing provider stress and cutting excessive costs at any time.

“The home hospital model could have an important impact on the ongoing response to the pandemic,” the report's author, David Levine, MD, MPH, MA, of the Division of General Internal Medicine and Primary Care, said in a press release. “Home hospital programs can create much-needed capacity by building on programs that many hospitals already have in place and do not require the financial and staffing resources of other approaches, such as field hospitals.”

The report focuses on the 95 days in 2020 between when Massachusetts declared a public health emergency (March 15) and the surge – defined as more than 30 patients hospitalized with COVID-19 – ended (June 18). Over that span, Brigham & Women’s treated 65 patients in their homes with a program that included remote patient monitoring, telehealth connections with the care team and daily visits by physicians, nurses and paramedics. The program was staffed daily by one physician, one or two nurses and a specially trained paramedic.

According to the report, roughly 60 percent were treated for infection, while another 22 percent were treated for heart failure exacerbation. The average length of stay in the program was five days, and 65 percent were successfully discharged. Roughly 12 percent of the patients were readmitted within 30 days, and almost 14 percent ended up in the emergency room within 30 days.

Levine has been the driving force behind Brigham and Women’s Home Hospital program since it was launched in 2016. Based in part on the success of that program, the Centers for Medicare & Medicaid Services created the Acute Hospital Care at Home waiver program in late 2020, giving healthcare providers a new payment plan for home-based services. More than 130 hospitals have signed on to the program so far.

"Hospitalization represents about a third of the roughly $1 trillion in annual health care expenditures in the United States," Levine said in a 2018 press release highlighting the program and study. "Saving a nice chunk of that through home hospitalization would produce massive savings that could be directed toward research and other public health endeavors."

The success of telehealth, remote patient monitoring and mobile integrated health concepts during the pandemic is giving healthcare organizations the confidence to develop new programs that take care out of the hospital and shift it to the home. Some are going the traditional RPM route, while others are mixing virtual and in-person services with hospital-based and home health care programs, even EMS and paramedic services.

The patient populations are diverse as well. While traditional RPM programs target those discharged from the hospital or in need of chronic care management, programs like Brigham & Women’s aim for patients who would otherwise be in the hospital. Still others are modifying the model to provide home-based care for people who might otherwise be in an assisted living or skilled nursing facility.

“We’re providing the same kind of experience that you would get at a SNF, but doing it in the patient’s own home,” Kelly Lannutti, MD, Mobile Integrated Health Medical Director and Program Development and Clinical Innovation Physician at South Shore Health, said of her health system’s SNF at Home program, launched last year. “It’s like Amazon Prime for our health system.”

“Home hospitals may represent a key response mechanism for a pandemic, but there’s also great evidence for their use when there isn’t a pandemic," Levine added in today's press release. "Patients have good outcomes, and they report great experiences receiving care at home."