As every physician already knows full well, health care services delivered to the home rather than in an institutional setting are increasing, a trend destined to expand even faster in the decades ahead.
This shift is inevitable, thanks to our rapidly growing elderly population and the corresponding prevalence of chronic illness, along with the nationwide push for higher quality care at lower cost and dramatic advances in medical technology such as telemonitoring.
But let me tell you something I’ve learned as a physician who has spent the last five years on the front lines of home health care: Most primary care physicians have yet to adequately recognize, understand and appreciate the role that health care brought directly to the home can play. If my ongoing efforts to educate physicians about post-acute care has revealed anything, it’s that its basic function and overall value clinically and economically remain largely a well-kept secret.
Here then, in the interest of setting the record straight, are what I’ve identified as the six major myths about health care at home that tend to persist among physicians — versus the objective realities:
Myth: Health care at home offers no clinical advantages over a hospital, nursing home or assisted-living facility.
Reality: Health care at home can improve patient outcomes — mounting evidence suggests it can lower the risk of infection, promote adherence to follow-up appointments and ultimately enable patients to live longer, healthier, higher-quality lives.Effectively managing chronic diseases at home can prevent many of the complications that lead to costly emergency room visits and avoidable hospital admissions. Attention applied on a one-to-one basis via health care at home also yields rewards difficult to quantify. Services delivered compassionately empower patients to live with dignity. People receiving health care at home may eventually move better, eat better, breathe better, and suffer less pain.
Myth: Health care at home rarely saves on health care costs.
Reality: Health care at home can shorten hospital length of stay, lower readmissions, cut emergency-room visits and thereby cut overall health care costs, in some cases sharply. According to MedPAC and the U.S. Census Bureau, health care at home cost half as much as hospital care – even if the hospital stay averaged only five days and home health lasted 120 days. The hospital cost was $10,043, or $1,853 per day, compared to $5,706 for home health care, or $48 per day. With home health, in other words, per diem cost was more than 100 times lower.
Myth: Health care at home typically provides little more than a custodial service.
Reality: It’s actually a multi-dimensional, multi-disciplinary provider of superior post-acute clinical service. The health care professionals enlisted to serve should, and often do, get more directly involved in patient care than ever before.
Myth: Health care at home is generally well-coordinated with hospitals, with proper protocols in place.
Reality: only about 20% of health care is actually integrated, by some estimates , while the rest remains fragmented,especially during and immediately after the crucial transition from hospital to home. Proper care calls for all the health care professionals involved — primary care physicians particularly, but also nurses, therapists and social workers — to be fully aware at any given time of which diagnoses are made, which tests administered, and which medications taken to collaborate efficiently. In the ideal scenario, the hospital physician contacts the post-acute physician who will be responsible for the patient, preferably in advance of discharge. Together, they discuss the case with an eye toward preventing recurrences. Hospitals form care-transition teams with a standard protocol for this handoff from institution to home.
Myth: Health care at home staff are generally unskilled aides.
Reality: highly trained clinicians, from nurses, nurse practitioners, physicians’ assistants, and physical therapists to pharmacists, speech therapists and social workers, are routinely deployed to home settings to do what they do, all the while serving as eyes and ears for the primary care physician.
Myth: Health care at home plays little or no part in driving down preventable hospital readmissions.
Reality: The number-one strategy that hospitals adopt to lower preventable readmissions is to partner with home health care agencies according to a survey conducted by HealthLeaders Media Intelligence Unit.
So there you go. The right partnership, with physicians and home health care operating side by side, will ensure that patients get the right level of post-acute care they need — at home. That’s more than good business. It’s also good medicine.
Michael Fleming, former president, American Academy of Family Physicians, is chief medical officer, Amedisys Home Health and Hospice.