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COVID-19 patients forgo hospitals so they can be treated at home instead

A nurse practitioner discusses health data with a patient recovering from pneumonia at his home
Nurse practitioner Sadie Paez discusses health data with William Merry, who is recovering from pneumonia at his home in Ipswich, Mass.
(Elise Amendola / Associated Press)

As hospitals care for people with COVID-19 and try to keep others from catching the coronavirus, more patients are opting to be treated where they feel safest: at home.

Across the U.S., “hospital at home” programs are taking off as the pandemic drags on, thanks to communications technology, portable medical equipment, and teams of willing doctors, nurses, X-ray techs and paramedics. That’s reducing strains on medical centers and easing patients’ fears.

The programs represent a small slice of the roughly 35 million U.S. hospitalizations each year, but they are growing fast with boosts from Medicare and private health insurers. And they stand to become more popular with consumers hooked on home delivery and other Internet-connected conveniences.

Eligible patients typically are acutely ill with common conditions such as chronic heart failure, respiratory ailments, diabetes complications, infections and even COVID-19. But they don’t need round-the-clock intensive care.

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Instead, patients are linked to 24/7 command centers via video and monitoring devices that transmit their vital signs. They get several daily home visits from a dedicated medical team. Just like in a hospital, they can press an emergency button any time for instant help.

Research on such programs over the last 25 years shows that patients recover faster, have fewer complications and are more satisfied, while costs can be one-third lower.

Doctors, hospital officials and patients tout other advantages: Patients get more rest when sleeping in their own bed. They can eat what they want, start moving around quicker and go outside for fresh air. They’re less likely to fall when they’re in familiar surroundings, where they have support from family and even pets.

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“I would recommend it in a heartbeat for anybody to be able to stay at home,” said William Merry, who received care for pneumonia in July at his home in Ipswich, Mass. “There was never any problem. Never.”

Merry, who had endured an uncomfortable hospital stay six years ago, refused another one when antibiotic pills didn’t improve his lung infection and his temperature hit 103. So his doctor arranged care through Boston-based Medically Home.

Nurse practitioner Sadie Paez looks over medical equipment in William Merry's dining room.
(Elise Amendola / Associated Press)

Merry and wife Linda, a retired nurse, said they were amazed at how quickly the service transformed their dining room into a mini-hospital room. Technicians set up medical equipment, gave them supplies and oxygen tanks, and explained how everything worked.

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That eased their stress, as did regular video calls with a doctor. They got daily schedules listing planned medical staff visits, blood draws, tests, IV medicine administration and other care, she said.

“I think it’s really important,” she cautioned, “that the person has somebody that’s able to be at home.”

Changes wrought by the COVID-19 pandemic have upended the lives of millions of dementia patients and their caregivers, who rely on long-standing routines.

Dr. Bruce Leff, a geriatrics professor at Johns Hopkins School of Medicine and a home hospital pioneer, did pilot studies years ago. He found benefits for elderly patients who, as he said, were otherwise “basically going to get crushed by the hospital” due to risks of developing blood clots and infections, losing mobility and developing delirium.

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Even before the COVID-19 pandemic emerged earlier this year, some hospitals were considering at-home-care programs to absorb temporary patient spikes and avoid the high cost of new buildings.

It’s unknown exactly how many U.S. programs exist, but when COVID-19 struck, some institutions rushed to sign up with Medically Home and similar services.

Nashville, Tenn.-based Contessa Health, which serves 14 hospitals in six states, says it’s adding two more hospitals shortly and is negotiating potential contracts for about 20 more. Patient volume has jumped 140% since last year, and the company has added care for patients “admitted” from urgent care and cancer clinics.

Another company, DispatchHealth, previously focused on preventing ER visits by rushing paramedics to provide diagnostic testing, medication and other care at patients’ homes or elsewhere. The Denver-based company says it has 200-plus contracts with insurers in 19 U.S. markets to treat seriously ill and injured people at home. After piloting a hospital-at-home program in November, it now has programs running in three cities and is planning a rapid expansion.

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Some hospitals have mounted their own at-home programs. In late March, eight of the Atrium Health system’s 36 hospitals in the Carolinas and Georgia began one for COVID-19 patients who don’t need intensive care. It’s already treated about 11,000 people.

Nurse practitioner Sadie Paez uses a stethoscope to listen to William Merry's chest.
Nurse practitioner Sadie Paez uses a stethoscope to listen to William Merry’s chest. Merry is recovering from pneumonia at his home.
(Elise Amendola / Associated Press)

Meanwhile, hospitals with existing programs are seeing far more patients choose at-home care.

In New York, the Mount Sinai at Home program went from handling 10 patients a month to up to 30, said its director, Dr. Linda DeCherrie. The program has since added a twist in which patients start care inside the hospital, then finish at home.

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“Everybody we offered it to said yes,” DeCherrie said.

The hospital-at-home model has been used on a small scale in the U.S. since the mid-1990s, she said, but it was held back because many insurance plans, including traditional Medicare, didn’t fully cover such treatment.

But when the pandemic struck, the Centers for Medicare and Medicaid Services temporarily let hospitals bill for care outside their walls, including in patients’ homes. Many private insurers also are covering in-home hospital care during the pandemic.

Hospital groups and others want Congress to make those changes permanent, at the same rates as in-hospital care.

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One in four people with diabetes have rationed supplies to cut the cost of their diabetes care since the start of the pandemic, a survey found.

Raphael Rakowski, co-founder of 4-year-old Medically Home, said the number of patients treated this July is up tenfold from July 2019.

“Our business is exploding because of COVID,” he said.

It now treats patients for 10 hospitals and one physicians’ group in five states, including two that were set up soon after the pandemic hit. Two Mayo Clinic hospitals joined this summer. Medically Home should be operating in 12 states by early 2021, Rakowski predicts.

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He said some patients are offered at-home care after being examined in an emergency room. In other cases, doctors arrange the care for patients getting cancer treatment, those with a sudden illness, some about to get surgery, or homebound patients with dangerous complications.

The Veterans Health Administration operates 12 hospital-at-home programs, which served 1,120 veterans last year.

More vets are using the program during the pandemic, said Dayna Cooper, head of the agency’s home-based programs. One of the busiest, in San Antonio, saw a 90% jump in veterans treated this March through June compared to last year.

Another four of the agency’s 170 hospitals are working to start programs. Cooper said studies of the programs in Cincinnati and Honolulu found they cut costs by 29% to 38%, without prompting differences in survival or hospital readmissions.

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While interest in the programs has skyrocketed, whether in-home hospital care blossoms after the pandemic largely depends on whether government and private insurers continue to cover it at profitable prices.

If they don’t, Leff said: “I think most hospitals will go back to normal.”


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