Stakeholders in all areas of the hospital seek to reduce costs and readmissions while maintaining excellent patient care. The latest initiative gaining popularity involves providing intensive care at home, which has the potential to ease bed-capacity problems, cut costs, and improve patient satisfaction. While few of these programs exist in the U.S., they have shown immense success in countries such as the United Kingdom, France, New Zealand, and Australia, according to experts from Massachusetts General Hospital and the Duke University School of Medicine.
In the ICU at home model, multidisciplinary care teams treat patients in their homes after receiving an initial evaluation and diagnosis in an emergency department or after a brief hospitalization. Some services offered by these care teams, often made up of nurses, include home infusions, telehealth visits, and on-site tests. Researchers believe patients who normally face multiple ICU stays from exacerbations of heart failure or chronic obstructive pulmonary disease would benefit the most from these at-home services. Other viable candidates include patients with pneumonia or stable pulmonary embolism.
Early adopters in the U.S. include:
- Presbyterian Healthcare at Home in Albuquerque, New Mexico
- 11 sites through VA programs
- Kaiser Permanente in Riverside, California
- Cedars-Sinai Medical Center in Los Angeles
Other related applications currently being evaluated to help reduce ICU costs include virtual health and remote monitoring of ICUs, which can keep staffing costs low. Additionally, having nurses coordinate care between the ER and home can help reduce both hospitals utilization and risk of readmissions. Central to this is patient education on post-acute follow-up care and proper medication management out of the hospital, which can reduce overall hospital readmissions.
Payments and Reimbursement
Rather than facing the extensive costs of an ICU, these programs offer a low-cost alternative that reduces hospital utilization while improving patient safety. However, as with other exploratory programs designed to reduce costs, receiving initial financial buy-in and backing from both providers and insurers remains a significant barrier to adoption. To begin reimbursement discussions, the CMS has proposed alternative payment models for programs such as ICU at home that may lead to a bundled payment approach.
Given the impact on patient safety and satisfaction, it is only natural that under value-based care, these stakeholders will soon recognize the benefits of reimbursing these services. As with any new model, buy-in will come over time and only with proven results.