Marilyn O’Brien, 88, took a nasty spill in early June that left her pelvis broken in three places and dealing with a “really uncomfortable” level of pain.
She spent zero nights in the hospital for it, and zero days recovering in a transitional care unit.
Instead, O’Brien made her entire recovery at home in Brooklyn Center, with husband Bill taking her vitals twice a day and zapping them to her doctor via the internet.
Marilyn O’Brien is one of the first patients to be discharged from the North Memorial Health Hospital Emergency Department and then admitted to the Hospital@Home program run by Lifesprk, a provider of private health services based in St. Louis Park. The program began in May in reaction to the COVID-19 pandemic.
“It’s convenient,” Marilyn said after she was discharged from the program Monday. “You feel like you’re treated on a more personal level.”
“It was a big relief. I haven’t done any nursing previously,” said Bill, 88, a retired engineer.
For some patients, the program has the potential to cut not just hospital time, but hospital bills, dramatically. Whether that’s a sustainable model in the long run will depend on whether insurers come to the table and let providers benefit financially from the savings.
Lifesprk’s Hospital@Home program with North Memorial is similar to others emerging around the country.
Mayo Clinic this month is launching a program to provide advanced care at home, in Jacksonville, Fla., and Eau Claire, Wis. Johns Hopkins Medicine in Baltimore has a long-running program, as does Mount Sinai Health System in New York.
In general, telehealth programs are becoming more common during the COVID-19 pandemic as insurers such as Medicare increase financial support for conducting doctors’-office visits, consultations and psychotherapy using video screens instead of in-person appointments. Telehealth has also been seen as a way to extend more complex medical services into rural and remote areas.
Hospital-at-home programs represent a type of telehealth specifically geared toward emergency patients. They are intended to divert medium-complexity emergency-department patients back home, where they can be more comfortable recovering in familiar settings, surrounded by familiar faces.
Dr. Nick Schneeman, a geriatrician and longtime Twin Cities health executive who is chief medical officer at Lifesprk, said Hospital@Home can provide a wide range of services in the home. Some are administered through a tablet computer from UnitedHealth Group’s Vivify Health unit.
Once a patient is admitted for home-hospital care by Lifesprk, they receive a box of supplies including the tablet computer and several health gadgets that communicate with it, like a pulse-oximeter to measure blood oxygen saturation, thermometer, blood pressure cuff and scale. The devices are returned after discharge.
Schneeman said patients get regular visits from nurses, just like in the hospital, and they can use the tablet computer as a 24/7 nurse-call button.
Many services are provided remotely, but the program also handles some in-person medicine, like collecting once-daily laboratory specimens, providing oxygen, running intravenous fluids, and conducting some imaging. The program is well-suited to patients with heart failure, acute renal failure, geriatric syndromes like weakness and falling, wound care, and bone fractures, he said.
The program is capable of treating COVID-19 patients, but so far has not done so.
The goals of Hospital@Home are to reduce the risk of transmission of COVID-19 in the hospital and ease the demand for personal protective equipment. “And, very importantly, to reduce social isolation that a lot of frail and elderly patients experience when they go into the hospital,” Schneeman said, calling visitor limits as “very appropriate.”
Hospitals and transitional-care units have been strictly limiting visitors to prevent the spread of COVID-19.
Right now Medicare doesn’t have a value-based system to pay for Hospital@Home, leaving Lifesprk to collect about $150 per home visit through a basic fee-for-service arrangement.
“Clinically, this thing has been a huge success, but the financial model isn’t there,” Schneeman said. “We are operating at a significant loss. But we are confident that we will prove value, and we are proving value, and that the payment methodology will come along.”