First of three parts
The following article by Nate Berg was published in FastCompany, magazine and online journal.
“Doctor Bruce Leff is a hospital skeptic. A practicing geriatrician who’s been on the faculty at the Johns Hopkins University School of Medicine for 25 years, Leff argues that hospitals don’t have their priorities straight.
‘“A lot of hospitals have what I would call an edifice complex,” Leff said. ‘All they want to do is build buildings.’
“Few would argue that hospitals aren’t important—see: The coronavirus pandemic—and Leff is not among them. But his concern with hospitals, and the hospital business, is that all those hospital buildings end up adding to the total cost of providing health care. ‘A lot of the money that rolls into hospitals goes to cover the fixed costs of maintaining those buildings,’ he said.
“Shifting the finances back toward the patient has been Leff’s goal since the 1990s, when he began pushing for hospitals in the United States to consider a concept known as ‘hospital at home.’ Common in Australia and pretty much what it sounds like, hospital at home enables some healthcare services to be provided to patients directly in their homes, freeing up hospital beds for more serious conditions and bringing down the overall cost of care. ‘You’re not using the dollar to pay rent. You’re not using the dollar to finance the hospital bonds that went into buying the building,’ Leff said. ‘You’re actually using the dollar to provide patient care.’
“That approach is becoming increasingly appealing to health-care systems. An estimated $3.6 Trillion is spent annually on health care in the U.S., and more than $1 Trillion of that goes to cover hospital care. Seeing room to bring that cost down and reap the profits, several hospital-at-home startups are now bringing this model to markets and patients across the country. They could revolutionize how hospitals provide care, and where.
“Twelve years ago, Raphael Rakowski was preparing to take a seat on the board of an academic medical center when his elderly father became ill and needed to be hospitalized. He ended up at the very medical center Rakowski was about to join. Sitting in his father’s hospital room, Rakowski, an entrepreneur with more than two decades of experience in health care, began a diary tracking the medical care being provided and the hospital’s workings—a kind of user’s perspective of the hospital he was going to help advise.
“Then something happened. A mistake was made—a medical error—and Rakowski’s father died. The sudden shock led Rakowski to look more deeply at the hospital and how it worked. One of his discoveries was that 68% of the cost of delivering care there went to brick-and-mortar overhead. ‘That led me immediately to the conclusion that 32% of the cost of care is inadequate to care for someone in an acute episode,’ he said. ‘I became obsessed with this idea of a bricks-and-mortar tax on services.’
“He set out to get rid of that tax and learned about emerging hospital-at-home efforts being attempted by people such as Bruce Leff. Rakowski said he and a business partner, Rami Karjian, stayed up for two days drinking Diet Coke and making a list of all the problems they’d have to solve for hospital-at-home to work. They came up with 188. ‘Regulatory, structural, operational, clinical, legal, financial. There was no shortage of things that got in the way,’ he said. Gradually, though, he said they figured out how to address many of these barriers and launched a company now known as Medically Home, based in Boston, which uses technology to bring doctors, nurses, and medical equipment, to patients’ homes, both physically and virtually.
“All he had to do was get hospitals on board. ‘I started going on a marched mission to convince hospitals to take patients out of their own hospitals, to care for them at home,’ he said. ‘And of course they’re in the business of putting heads on beds and not in the business of discharging patients, so it was a very lonely, expensive, and time-consuming, effort to get thrown out of some very famous health systems.’
“But as technology improved, two-way video calls, remote monitoring of patient vital signs, and easily portable medical equipment such as electrocardiogram machines made it possible to provide more care more reliably in peoples’ homes. Patients who’d otherwise be admitted to the hospital for pneumonia or low-blood flow related to congestive heart conditions or an infected wound can now be treated directly in their homes.
“Medically Home is working with health-care systems in five states and soon will be expanding into two more. Its recently found a partner with the Mayo Clinic and is now operating in two of its markets, in Florida and northwest Wisconsin. Using Medically Home’s technology, the Mayo Clinic can have its doctors make scheduled virtual rounds by way of video connections in patient homes, where a nurse or contracted paramedic is standing by to administer intravenous fluids or otherwise be the doctor’s hands. Vital signs are streamed directly to the doctor’s control center, and Medically Home’s software coordinates the delivery of medication or the scheduling of visits by specialists such as physical therapists. Unless the patient’s condition worsens to the point of needing to go to an ICU, nurses and other practitioners administer care based on the orders of the doctor. In the majority of cases, the doctor can guide treatment without leaving their office.”
Continued at thevoice.us/hospitals-at-home-save-lives-save-money-efficient