Hospital-level treatment at home

Any widespread change in Medicare rules will have Macroeconomic impact. This article describes changes that (supposedly) give people hospital-level care at home.

In a matter of weeks [after the March 2020 Covid tsunami], C.M.S. [Center for Medicare Services] was able, with the help of experts, including some members of the Users Group, to come up with a waiver that reimbursed health systems as much for inpatient-level care in the home as in the hospital, even though room and board wasn’t being provided. Nurses no longer had to be on site around the clock — only a minimum of two daily in-person visits by a nurse or a paramedic with additional training were required. Verma recalls no pushback. A handful of hospitals received the C.M.S. waiver immediately, including Presbyterian, Mount Sinai and Brigham…

Today more than 110 health systems, amounting to some 260 hospitals — or about 5 percent of the country’s total — have obtained the waiver. (Geographically, the spread of home-hospital has been uneven; fewer than 10 rural hospitals have been approved so far.)

The pandemic conditions that propelled hospital-at-home programs in the United States may now be waning, but the movement itself is maintaining its momentum. According to the consulting firm McKinsey, up to $265 billion worth of care annually being delivered in health facilities for Medicare beneficiaries — a quarter of its total cost — could be relocated to homes by 2025…An increasing number of companies like Medically Home have moved into the home-hospital business, among them Contessa, DispatchHealth and Sena Health…[end quote]

I can think of many reasons why this is a bad idea. The distance from the doctor who isn’t hands-on with the patient to detect problems. The time and distance from the hospital if anything goes wrong. The extension of the current bad tendency of doctors to rely on tests and telemetry instead of their own medical senses. The lack of orderlies to help patients walk around and go to the rest room.

Given the high expense of new hospital beds, hospital managers may be pushing this new model.

But I’m sure it won’t be coming to my rural area since it’s only practical for large, closely-spaced patient populations.

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Some currently hospitalized patients probably can be cared for at home with proper support.

Health care is a labor intensive business. Working to reduce costs is to everyone’s benefit. But of course its about choosing the right patients. Outcomes should guild the decisions.

In addition we know that many get exposed to infectious diseases in hospitals. Home can be a healthier option.

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This does not work against that. Meaning we do not fully know if a doctor can insist a patient be hospitalized in later stages of disease etc…We are only assuming patients in dire need of care will opt to live at home. Some of that is already happening. In those cases nurses and aids will be paid hospital rates which is fair.

There is a larger mix of options here. Most of this is about pay.

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Ditto. But it is the future. My biggest concern is the old “slippery slope”.

When DW had her hysterectomy several years ago, it was done as an outpatient procedure. Of course she had the ideal setup with me being an anesthesiologist I could deal with the simpler post-op complications. Plus, she went home with an IV (not exactly protocol at the time). Plus, I’m big enough and strong enough to be the orderly. Things went fine and DW preferred to be home instead of the hospital.

Within the past couple of years, there has been a push for total joint replacements to be done outpatient. Of course you have to be selective about the patient, but that slippery slope is very real. I’ve worked with too many surgeons that argue “well we did it last time with just as sick a patient, do will really need all those precautions again?”. Well, you didn’t roll a 7 at the craps table last time either.


This is not new. I had a hip replacement in late 2004. People who had other adults living with them went home in 2-3 days. Because I lived alone, I could not be sent home. Instead, I was in a rehab facility for 10-14 days. Once rebab was completed, I went home.

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Time was when new mothers were kept in the hospital for days after the birth. Now days most go home the next day.

Similarly many simple surgery recoveries can be done at home–unless there is some complication.

Sure severely ill patients should be in the hospital. But hospitals deal with dozens of routine, no hassle patients every day. Rather than strict rules, we need good judgement based on how each patient is doing and their needs.


Yep but the 7 can be a death in a hospital or nursing home by pneumonia. Sending the elderly home if possible 3 days after a hip fracture has saved a lot of lives.

Hospitals are the last place you want to be if you are sick. You know that on the flip side.

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