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Since the COVID-19 public health emergency (PHE) was enacted in 2020, there has seemingly been a new type of care brought to the home every six months or so.
Those include skilled nursing facility services in the home (SNF at home), kidney care at home, infusion services at home and ancillary cancer care in the home, among others.
The latest, however, appears to be the most daring one thus far, and that is emergency department care in the home.
Over the course of the last few weeks, ED in the home has been shoved into the spotlight by a few organizations, but namely Medically Home, one of the pioneers in the hospital-at-home space.
Earlier this month, Medically Home announced its “ED in Home” program, which is specifically tailored to medically complex patients. It was designed by emergency care physicians.
“Medically Home is committed to decentralizing care outside of facilities, and back to where people, patients and their families feel best — which is in their homes,” Dr. Pippa Shulman, chief medical officer at Medically Home, told Home Health Care News.
The goal of ED in the home is the same as the other types of migrating care services: keeping patients in the home to improve comfortability and outcomes while reducing costs. Hospital at home and ED in the home also have the add-on benefit of keeping hospital capacity at manageable levels.
For this week’s exclusive, members-only HHCN+ Update, I delve into the latest ED-in-the-home developments and whether or not the model will proliferate.
ED in the home
Medically Home is a Boston-based company that helps health systems and other organizations deliver hospital-at-home services. It helps the coordination of in-home visits, and helps provide the staffing, technology and equipment necessary.
Its ED in Home program has already served 5,000 patients. Over 80% of those patients stayed at home without requiring transfer to the hospital, according to the company. It is live in Massachusetts, and Medically Home hopes to quickly expand.
The program is different than hospital at home for obvious reasons. While hospital at home helps avoid inpatient hospital stays, ED in the home – like the name suggests – keeps patients out of the emergency department.
Patients can be those with shortness of breath, a cough, or a fever. They can also can be those that have recently experienced a fall and perhaps a broken hip, for example, according to Shulman.
This week, UCM Digital Health (UCM) and MVP Health Care (MVP) announced a new program that will give MVP plan members access to emergency room-level care in the home.
The program has promise because the emergency department – especially for undeserved populations – can act as a primary care physician when one does not exist for the patient.
Nipping that trend in the bud is the promise that ED in the home brings.
“Specifically, when it comes to emergency department care in the home, I do think that is going to be a critical need,” Kaiser Permanente’s Dr. Stephen Parodi told me earlier this month. “Why do I think that? If there’s anything that we’re seeing coming out of this pandemic, it’s that our emergency departments are extremely busy. They’re at unprecedented levels of patients that are coming in. And what we’re seeing within Kaiser Permanente, is that these patients are sicker.”
Parodi is the executive vice president of external affairs, communications and brand at The Permanente Federation, as well as the associate executive director of The Permanente Medical Group.
Specifically, in Kaiser Permanente’s case, it has a five-point scale to determine how sick patients are. Its top two levels of acuity have gone up the most in the past five years, a trend Parodi believes will continue.
To make matters worse, emergency department infrastructure has not grown all that much, he said.
“I think there’s actually a need for being able to provide this type of service somewhere other than a traditional emergency department, if we can do it safely,” Parodi said. “So I do think this is a new area of opportunity and frontier for being able to provide effective services.”
Of course, the word “safely” is the key one above. Safety issues with home infusion, for instance, were recently outlined in a study published in the American Journal of Infection Control.
But ED in the home could also go a long way to engage more providers to enter into hospital at home. As Parodi pointed out, ED in the home would be natural extension to hospital at home, where one could take patients from an ED-in-the-home program straight to a hospital-at-home program.
“Why not just do that all in the home?” Parodi said. “I would love to realize that vision, and I’m excited by the potential opportunity here.”
Currently, the majority of U.S. states have hospital open-bed capacities lower than 30%. Overall, more than 77% of beds are filled as of Thursday, according to the U.S. Department of Health and Human Services (HHS).
“Emergency departments in this country were overcrowded before COVID,” Shulman said. “There were reports on the crisis in our hospitals in 2019. They continue to be places where people are unfortunately waiting. Not being able to be seen doesn’t make anyone feel good. To be able to triage patients to the right point of care is better for our health care system, and most importantly, better for patients and their caregivers.”
As with all of these models, there’s a place for traditional home-based care providers. Most of the models are new, and oftentimes they rely on staff – or family members – that are inexperienced in home-based care.
I wrote about that opportunity earlier this month as well.
It’s hard to quantify without data, but home care and home health providers’ experience would make the idea of ED-in-the-home safety more plausible instantly.
Either way, I suspect the model to be here for the long run, based on what it can do for hospitals and for patients.
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