Background: Hospital at Home programs originated as pilot initiatives on a national scale, gaining momentum during the COVID-19 pandemic. The need for reevaluating healthcare delivery systems became pronounced during this period. Kent Hospital in Rhode Island collaborated with key stakeholders, including Blue Cross Blue Shield of Rhode Island, United Health Care, and CMS, to bring hospital services into the home environment.
Purpose: Describe patient selection process for Hospital at Home program, considering factors such as diagnosis, severity of illness, support systems, insurance requirements, and utilization review challenges, including difference in inpatient criteria, denial management and the nuanced boundary between inpatient and outpatient care.
Description: Hospital at Home programs gained momentum nationally during the COVID-19 pandemic, prompting a healthcare delivery system reevaluation. In 2020, CMS authorized the Acute Hospital Care at Home initiative. Kent Hospital, in collaboration with Blue Cross Blue Shield of Rhode Island, United Health Care, and CMS, pioneered extending hospital services into homes—a first in Rhode Island.Physician advisors and the Hospital at Home team assess patient eligibility through daily multidisciplinary rounds. Initially, the diagnosis list was limited for program growth. The patient catchment area was more localized for swift hospital return if needed. Patients needed robust support and home navigation skills. The physician advisor’s primary role is determining care level and acute service necessity.Due to meticulous patient selection, the emergent readmission rate is under one percent. Post-discharge readmission rates, around ten percent, mirror traditional hospitals. Despite triumphs, a significant obstacle remains: one-third of medically eligible patients couldn’t participate in 2022 due to insurance ineligibility.The main challenge is identifying acute care level patients who can safely transition home. To address this, the program proactively recruits from the emergency room, enhancing hospital throughput. Denial management, a physician advisor responsibility, is complex due to the less distinct inpatient and outpatient care boundary. Guided by physician advisors, the Hospital at Home team manages peer-to-peer calls and collaborates on appeal decisions.Through seamless collaboration, the Hospital at Home and physician advisor teams successfully provided acute care to Rhode Island patients at home.
Conclusions: In conclusion, the Hospital at Home program in Rhode Island, pioneered by Kent Hospital in collaboration with insurers and CMS, has proven successful in delivering acute care services in a home environment. The program’s meticulous patient selection process, daily multidisciplinary rounds, and limited initial diagnosis list contribute to remarkably low emergent readmission rates. Despite its triumphs, challenges include insurance ineligibility for a significant portion of medically eligible patients and the complexity of denial management due to the less distinct boundary between inpatient and outpatient care. Proactive patient recruitment from the emergency room has been employed to address challenges and enhance hospital throughput. Overall, the program’s success has led to discussions about expanding the diagnosis list and broadening insurance contracts, highlighting the potential for innovative healthcare delivery models.