After months of bracing for a COVID-19 surge, hospitals in my home base of Seattle and other communities nationwide are finally coming up for air. The immediate crisis appears to be over. We’re realizing that we won’t be shifting to a crisis care standard or running out of beds — at least not this time around.
For decades, hospitals have operated in a costly and fragmented system that leaves many patients behind. Now COVID-19 has cracked open the door of potential for new and better ways of care delivery. We now have a fleeting window of opportunity to push this door open for all patients.
As it spread across the country, COVID-19 swept aside healthcare reform, genomics, and artificial intelligence to establish itself as the disruptor of all disruptors. After decades of stalled progress, it’s precisely the urgency of the pandemic that makes transformative change possible right now.
While outpatient medical offices are rapidly redefining themselves as they scramble to extend care beyond their walls, hospitals haven’t transformed to the same degree. With so many patients and physicians enthusiastically adopting telehealth, hospitals need to disrupt their care delivery as dramatically as outpatient clinics. As CMS administrator Seema Verma put it, “The genie is out of the bottle.”
Perhaps the greatest opportunity for transformation exists in acute and post-acute care. Since the start of the pandemic, emergency departments, inpatient units, ICUs, skilled nursing facilities, and care navigation programs have raced to implement telehealth to protect team members, conserve PPE, and expand hospital capacity. While technology will never replace hands-on care completely, it could help us to combat some of the tough existential challenges our hospitals faced even before the pandemic.
One innovative example of acute care telehealth is Hospital@Home, a joint initiative between Vituity and California-based Adventist Health. Hospital@Home is a 150-bed virtual hospital that provides telehealth rounding, remote monitoring, and in-home visits from nursing and ancillary teams. Participating EDs and medical offices assess patients and make referrals as appropriate. Eligible diagnoses include congestive heart failure, COPD, and COVID-19 not requiring hospitalization. In addition to satisfying patients and protecting providers, the program reduces the cost of care.
While initially designed to free up inpatient capacity for a potential COVID-19 surge, new telehealth-driven models like Hospital@Home could pave the way for virtual waiting rooms, telenavigation, teleSNF, and other innovations in acute and post-acute care that benefit all patients.
Like most emergency physicians, I often struggle with tough disposition decisions. If I send the patient home, will they be able to follow-up with their primary care provider in a timely manner? And will that provider have the infrastructure to check in and keep a pulse on them?
Often, it’s easier to admit a patient for observation. Unfortunately, this has a financial cost for everyone involved. Typically, the patient pays more out of pocket while the hospital receives less revenue.
Fortunately, remote monitoring programs like Hospital@Home could potentially bridge the gap. I would be more likely to discharge my higher-risk ED patients home with this continuum of care in place. In addition to saving everyone money, this approach would likely improve the patient experience.
Hospitalists also face difficult decisions when discharging patients. Will the person be safe at home? Does the family have the resources to care for them? The stakes are especially high during the pandemic because skilled nursing facilities are at increased risk for outbreaks. Again, telehealth and remote monitoring could provide sustainable, cost-effective solutions that allow more patients to go home sooner.
While COVID-19 has created unprecedented challenges for hospitals, it has also opened a whole new world of opportunity. Hospitals need to act fast to capitalize on the urgency, regulatory openness, and public goodwill that enables radical transformation.
As hospitals pursue change, it’s important to remember that our entire healthcare system is emerging from a period of high anxiety and trauma. Change must be approached with sensitivity and invitations for input and engagement. However, it must be initiated now, while the window of opportunity is open. We owe nothing less to our patients and communities.