When Intermountain Healthcare considers a patient for hospital-at-home care, caregivers assess their living situation. In one case, the evaluation solved a mystery.
The patient felt dizzy and had low blood pressure. He was otherwise in stable condition and a good candidate for hospital-at-home care. Ideally, it could free up bed space at the integrated system’s hospitals and boost his recovery.
During the assessment, Intermountain staff found blood pressure medication that no one knew he was taking. Nurses cleaned up his medication box and got him back on track, said Dr. Nathan Starr, director of home services for Intermountain at Home.
“These are issues we don’t see in the hospital,” said Starr, an internal medicine physician who also leads Intermountain‘s telehospitalist program. “We fundamentally believe in not just preventing readmissions to reduce costs, but investing in a cheaper model of care to produce cost savings that should be shared by more than the health system.”
Many health systems are building out the infrastructure to bring more acute treatment into patients’ homes as they look to free up inpatient capacity, bridge care gaps, improve quality and reduce costs. But their philosophies differ.
Some argue that they have a moral obligation to pass the cost savings on to payers and patients by reducing their charges. Others believe that fewer readmissions and better outcomes will drive cost savings, not necessarily changing what they bill payers.
Mirroring current fee-for-service reimbursement would perpetuate healthcare cost inflation, given that hospital-based care accounts for about a third of the nation’s annual $4.1 trillion healthcare bill, industry observers claim.
About half of the health system executives Modern Healthcare interviewed said they weren’t sure if they would charge insurers facility fees, which are meant to offset hospitals’ costs associated with providing around-the-clock care, stricter licensing and regulations, and specialized equipment. While there are upfront costs to set up the technology and coordinate services for hospital-at-home programs, charging a potentially $1,000-plus facility fee is disingenuous, some experts argue.