The COVID-19 pandemic brought doctors to patients’ smartphone screens.
Now it’s bringing hospitals into their homes.
Northwell Health and Catholic Health are poised to launch small but groundbreaking new Medicare programs offering hospital-level care at home, part of a nationwide effort to lessen the pandemic’s impact on patients and health-care facilities alike.
Northwell’s North Shore University Hospital and Catholic Health’s six Long Island hospitals are set to debut “Hospital at Home” service, giving Medicare-reimbursed care to patients who otherwise would be treated in hospitals.
Covered treatments and conditions
Medicare’s Hospital at Home can provide services such as:
The national program is open to patients who have fee-for-service Medicare and who are suffering from illnesses including:
Patients receive in-person visits from nurses or other care providers twice a day, plus video calls with doctors and remote monitoring of vital signs.
Sources: Centers for Medicare & Medicaid Services, American Hospital Association
The new program can include services such as X-rays, cardiac ultrasounds, oxygen treatment, intravenous medicine and skilled nursing for patients suffering from illnesses such as pneumonia, congestive heart failure, pulmonary disease and diabetes. Patients receive in-person visits from nurses or other care providers twice a day, plus video calls with doctors and remote monitoring of vital signs.
Medicare’s Hospital at Home program operates at a relatively modest scale nationally, with 1,878 patients treated as of late October, a New England Journal of Medicine publication reported. But the new program and others like it have begun to reshape the health care industry as a growing number of services move out of hospitals and into outpatient facilities and homes, a change enabled by increasingly sophisticated technology, health care industry executives said.
Many severely ill patients actually do better at home than in hospitals, research has shown. Most studies have found that costs are lower at home, mainly due to shorter length of treatment, fewer consultations and less testing; one study found a 19% reduction in costs. Plus, providing care at home lightens the load for health care facilities facing crowding during the omicron surge.
From crisis, innovation
“Crises often lead to innovation,” said Wendy Darwell, president and CEO of the Hauppauge-based trade group Suburban Hospital Alliance of New York State.
Medicare opened up the program in late 2020 “as a mechanism to really provide a relief valve for hospitals,” Darwell said. “We needed to be able to free up beds because there was such a tidal wave of patients coming in, and at some point patients need a reduced level of care but aren’t completely ready to be discharged.”
Also, she said, “the reality is, the vast majority of patients would rather be at home than in a hospital bed.”
That’s true for Thadeus Rydzewski, 83, a retired supervisor at Grumman, volunteer fireman and Army veteran who lives in Locust Valley. Rydzewski, who has congestive heart failure and chronic obstructive pulmonary disease, was hospitalized three times last year. He needs portable oxygen and a walker when he leaves the house, making each trip to a doctor’s office an endurance test for him and his wife Mary Jo, 81.
Rydzewski is not part of the soon-to-launch Hospital at Home program. However, in December he joined a separate program called Northwell Health House Calls for chronically ill patients who have trouble traveling. He now receives home visits from a primary-care doctor who checks his heart and lungs. He has a tiny device implanted in an artery that monitors symptoms of heart failure and transmits the data to his caregivers.
On a recent morning, Rydzewski settled into a maroon recliner in his living room, surrounded by family photos, for a checkup with his physician, Dr. Jana Galan.
“How has your breathing been lately, OK?” Galan asked Rydzewski after using a stethoscope to check his lungs.
“Yes, yes,” he told her.
Less stress at home
Rydzewski has also gotten a chest X-ray in his home as well as his COVID vaccinations and a quick-response visit from paramedics when he had trouble breathing.
“The service is great, I love it compared to what I used to be doing,” he said. “There’s less stress, and I don’t have to worry that something could happen to me.”
Northwell’s new Hospital at Home program, which will provide an even higher level of care, is expected to start with about six patients. The Catholic Health counterpart aims to provide treatment to a limited number of patients recovering from COVID-19. Both programs are expected to launch soon, although exact dates aren’t set.
The new local programs were made possible when Medicare, the federal system that provides health insurance to 62.7 million seniors, began allowing hospitals to apply for special permission to operate temporary Hospital at Home services during the pandemic. So far, 201 hospitals across the country have received permission since the program’s launch in November 2020.
Patients in the voluntary program must start off in a hospital emergency room or inpatient ward and undergo an in-person doctor’s exam before enrolling.
Medicare’s Hospital at Home program complements other in-home health care programs that have grown during the pandemic, as patients, providers and insurers sought ways to reduce unnecessary trips to overburdened health care facilities.
For example, UnitedHealth Group’s HouseCalls program has conducted more than 10 million in-home visits by nurses and other providers since 2012.
“While in-office care will remain indispensable for many health care needs, we expect the trend toward alternatives like in-home care and virtual-care programs to continue,” Dr. Philip Painter, chief medical officer for UnitedHealthcare Medicare & Retirement at the Minnesota-based insurer, said in a statement.
In addition to its new hospital-care program, Medicare also offers lower-level, in-home care by nurses and other providers. Medicare has seen a 50% jump in the volume of in-home visits in the two years ending in October 2021, said Oleg Bestsennyy, a partner with McKinsey & Company who focuses on health care innovation. McKinsey estimates that as much as $265 billion in Medicare spending — about 25% of the total — could shift to patients’ homes by 2025 without reducing quality or access.
Not for everyone
Not all patients can be treated at home, particularly those at high risk of needing emergency care, providers say. Some “need services that we can only do in the hospital,” said Dr. Albert L. Siu, chair emeritus of the Brookdale Department of Geriatrics and Palliative Medicine at Icahn School of Medicine at Mount Sinai, who helped lead one of the first Hospital at Home programs at Mount Sinai Hospital in Manhattan from 2014 through 2017, when the safety and feasibility of such programs was being studied.
But for the right patients, home treatment can lead to better care, with fewer falls and infections, doctors say. In-depth studies of early Hospital at Home programs have found patients with illnesses such as pulmonary disease and stroke were safer and more satisfied with their care than those treated in hospitals.
At Mount Sinai, they “had fewer hospital readmissions and emergency department visits,” Siu said.
Providing treatment at home also helps reach patients who remain reluctant to visit health-care facilities. A recent survey by Mount Sinai South Nassau hospital in Oceanside found that 43% of respondents had put off routine checkups during the pandemic.
For COVID patients
Many people recovering from COVID have difficulty breathing and have lost strength, said Francene Stauber, assistant director for rehabilitation services in the home care department of Mount Sinai South Nassau.
So the hospital launched a pulmonary rehab program that includes nursing, physical therapy, dietary counseling and other services in patients’ homes, she said. It brought about “a marked improvement in these patients’ abilities to navigate around their home, and even leave their home to get to doctor’s appointments or houses of worship or anyplace else they need to go,” she said.
Even before the pandemic, at-home health care was becoming more available.
Northwell, which owns and operates 19 hospitals and has 830 outpatient facilities, has been offering house calls from doctors, nurses, physical and occupational therapists and other providers for years. Those programs have grown during the pandemic, said Dr. Zenobia Brown, vice president for population health care management at Northwell Health Solutions.
The system’s House Calls program served 1,941 senior citizens with chronic illnesses on Long Island and in Queens and Manhattan last year, up about 7% from 2019, according to Northwell.
Physical therapy, homestyle
Northwell said it also provided traditional home care services such as in-home nursing, rehabilitation, postoperative and palliative care, among other services, to about 50,000 patients last year, nearly double the 27,500 served eight years earlier.
Among Northwell’s physical therapy patients is Delicia McErlain, 75, who lives in Floral Park and is recovering from a fall that broke bones in her right wrist and upper arm. Her injuries made it impossible for her to drive herself to appointments, so she sought at-home treatment. Her physical therapist, Bonnie Yu-Hsuan Lee, has taught her exercises she can do by looping a towel through a railing in her kitchen, or by moving a roll of paper towels back and forth on a table.
There are some services offered in physical therapy offices that you can’t easily replicate at home, but there are improvised alternatives that work well, McErlain said.
“If you go to a place with equipment, you don’t know how you’re going to use that, or you’re not going to use that at home,” McErlain said. “Whereas when she’s here … with her being so creative, you know, we’ve been finding things to do.”
Like Northwell, Catholic Health also has seen an increase in at-home services, including after joint replacement surgery, said Dr. Kerrianne Page, chief medical officer for hospice, palliative care and home care services at the health care system.
“A few years ago, people might have kind of automatically gone to an inpatient setting for rehab,” Page said. “Now many more people go home, in part because it’s, from a health-care economics standpoint, beneficial, but most importantly, because the patients recover as well, if not faster, in the home setting. They’re less likely to have complications like infections or other problems. And they’re more comfortable.”
Catholic Health also offers at-home sleep studies for patients at risk of sleep apnea. Ricardo Ramirez, a biomedical engineering tech at St. Charles Hospital in Port Jefferson, was hospitalized for about two months for a severe case of COVID in early 2020. Afterward, Ramirez, 54, who lives with his wife and two children in Rockville Centre, was having trouble sleeping. After using a home device to monitor his breathing overnight he went for further examination at a Catholic Health facility and was diagnosed with apnea. Now he uses a CPAP device that helps keep his airway open while he sleeps and transmits data to his health care providers.
Someone ‘watching over me’
The device “makes a big difference,” said Ramirez, who has private health insurance. Plus, he said, with the remote monitoring, “I have somebody that is watching over me at night. If there are issues, I know they will let me know.”
The health care system had more than 5,000 patients receive remote monitoring of vital signs last year, a 26% increase from 2019, Page said.
For its Medicare Hospital at Home program, Catholic Health plans to begin by offering at-home care for patients receiving intravenous treatment for COVID, Page said.
For some patients, staying at home is their top priority, no matter how serious their condition. Bernice Campbell, 86, has suffered two strokes, she has diabetes, kidney disease and other ailments and she was hospitalized seven times from 2019 through mid-2021. She said her doctor encouraged her to consider moving into an assisted living or rehab facility.
But Campbell just wanted to return to the house in Westbury where she has lived for 56 years. She can spend time with friends, surrounded by her photos, books and African art, and volunteer at her church.
“I was in a rehab center for a while, but nothing is like being at home and that’s what I want,” said Campbell, a retired senior supervisor at a chemistry lab at Mount Sinai Hospital.
Campbell and her doctors at NYU Langone Hospital-Long Island in Mineola came up with a plan that included physical therapy, medication management and nutrition, with in-person visits and remote monitoring. She received the services for about three months after her release from the hospital last summer.
“Every morning I would take my vitals and it would automatically be sent over … and the nurse would review it and if they had any questions or if it was abnormal, they would call me and we would have a conversation about what to do,” she said. “It was very reassuring.”