MetroHealth’s ‘hospital at home’ vision could soon shift even inpatient or ICU care to a virtual model – cleveland.com

MetroHealth on Thursday announced plans to reinvent the "hospital at home" model of health care. The goal is to offer an entire continuum of care to patients at home, which would include primary care visits, outpatient care and even some inpatient-level services.Rich Exner, cleveland.com
CLEVELAND, Ohio – The COVID-19 pandemic forced hospitals across the U.S. to adapt a telehealth model to treat patients at home. MetroHealth is looking to make that shift permanent through a bold new vision that could see everything from outpatient services to inpatient care being offered to patients who never have to leave their house.
The model MetroHealth outlined during its annual stakeholders meeting Thursday is different from “hospital in the home” programs offered at other U.S. hospitals. MetroHealth is looking to reinvent traditional health care delivery, President and CEO Dr. Akram Boutros said in an interview with editors and reporters from cleveland.com and The Plain Dealer.
“This is not an evolutionary approach to virtual care or telemedicine. This is revolutionary. We’re designing it from the ground up,” Boutros said during the meeting. “We’re putting the traditional system aside and starting from scratch.”
What would distinguish the MetroHealth model, which will roll out in 2022, is its focus on the entire continuum of care for a patient, the health system’s Executive VP and Chief Clinical Transformation Officer Dr. Nabil Chehade said in an interview.
In practice, that would mean a patient’s primary care visits would be virtual, and they would have access to wellness services to keep them healthy. If they need an X-ray or blood work, a MetroHealth nurse or technician could come to the patient’s home to save them a trip to the hospital, Chehade said.
Some patients could even receive inpatient care from home, Chehade and Boutros said. For example, a patient who receives a hip replacement could recover at home instead of in the hospital. MetroHealth doctors and nurses could monitor the patients to see whether they’re moving enough or doing physical therapy.
If the patient’s vital signs show a problem arising – like if the patient is developing a blood clot – MetroHealth could send in a team of doctors and nurses who would treat the patient and stay with them until they’re stable.
“That’s not for everything, of course. We’re not doing surgeries at home,” Chehade said. “But a patient could access an increasingly acute level of care when they need it and remain at home.”
MetroHealth also sees other benefits in at-home care for patients. Studies have found “hospital at home” programs can reduce health care costs, prevent infections and improve outcomes for patients.
MetroHealth is thinking even bigger for its long-term goal for the program. Within five years, the health system is looking to expand the program to ICU patients with long-term conditions, such as chronic heart disease or sepsis, Boutros said in the meeting with cleveland.com and The Plain Dealer.
“Some things can’t happen. But there are other things that can. The chronic medical diseases – heart failure, COPD, renal failure, sepsis – all of those things can be done,” Boutros said during the meeting.
Accelerated by COVID-19
MetroHealth has been ruminating over the idea of a “hospital at home” program for several years, but the plan kicked into high gear during the COVID-19 pandemic. To protect patients from contracting COVID at hospitals, the health system transitioned many of its services to remote.
In addition, MetroHealth offered used home monitoring to offer inpatient care to approximately 700 patients during the pandemic, Chehade said. The majority of those patients had COVID-19, but the symptoms were not serious enough to warrant a stay in the hospital.
The success in remotely monitoring patients at home made MetroHealth’s decision-makers realize they could move a little more quickly to adopt some of their long-term goals.
“[The pandemic] pushed us to accelerate that innovation,” Chehade said. “It made us realize that this is not 20 years away. The first few steps can be taken safely right now.”
MetroHealth already has the infrastructure in place to begin the transition, because it’s been used to treat the 700 patients at home during the pandemic, Chehade said. Patients are given basic medical equipment, such as blood pressure monitors, as well as Apple iPads already hooked up to a 4G LTE connection paid for by MetroHealth. Teams of doctors and nurses monitor the patients 24/7 and will be ready to respond to any issues, or call an ambulance for an emergency.
The idea of a “hospital at home” program has been floated for decades, at least in a more limited capacity. Johns Hopkins University Dr. Bruce Lee developed a model a quarter-century ago after noticing many of his geriatric patients had worse outcomes being admitted to the hospital.
Presbyterian Healthcare Services of New Mexico launched its Hospital at Home program in 2008, offering inpatient-level care to patients stable enough to be treated at home.
However, those types of programs struggled to gain traction because they were not eligible for reimbursement through Medicare and other health insurance plans.
That began to change in late 2020, when the Centers for Medicare and Medicaid Service launched a new program to expand the eligibility of “hospital at home” programs. The new program covers more than 60 medical conditions, including asthma, chronic obstructive pulmonary disease, congestive heart failure and pneumonia.
Boutros said MetroHealth’s program should also be covered by Medicare and other health insurance.
It’s also likely the cost to a patient will be cheaper through a “hospital at home” model, Boutros said. Hospitals in Israel that used a similar approach found at-home care cost half as much as a traditional hospitalization.
Taken altogether, the benefits of moving to a “hospital at home” approach to health care are clear to MetroHealth, Chehade said.
“Health care is evolving, and we understand we need to leverage technology, just like all other industries, with the aim to deliver better care and more accessible care at a lower cost,” he said.
What’s next?
MetroHealth has already developed a platform for its program. The health system is now in the process of forming a company designed to provide health care to all patients who are stable enough to stay at home instead of being admitted to a hospital.
The health system is also looking for five to six health care and technology partners to help them scale the program to the point where it could be offered nationwide, Boutros said during the meeting.
It’s unclear how much it will cost to roll out the model in Greater Cleveland or scale it to a national level, though Boutros estimated the latter effort could carry a $500 million price tag. However, a very large portion of that cost could be paid by investors, such as technology companies, he said.
The entire “hospital at home” program won’t be ready from the start. It will be implemented in waves, as the hospital grows more comfortable with monitoring various types of patients from home, Chehade said.
“As we refine our protocols and as we are able to bring in a multidisciplinary team to care for the patient remotely and at home, that level of care will start escalating,” he said.
Eventually, though, Chehade believes 30 to 50% of non-surgical inpatients on regular medical floors could be monitored from home. And in three to five years, roughly 80% of outpatient visits could be online or at home, he said.
Boutros told editors and reporters from cleveland.com and The Plain Dealer that MetroHealth sees the effort as a step toward fulfilling the promise to make health care more patient-centric. Many hospitals have been touting that goal, but patients are still asked to schedule and travel to an appointment. Bringing services to a patient at home would be a true “patient-centric” approach to health care, Boutros said.
“[What] we’re saying is we’re going to fulfill the promise of patient-centric care,” he said during the meeting.
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