The hospital’s case for funding home care
Hospital rounds start every morning with the senior physician asking the residents, “Which of our patients can go home today?” The shrugs and eye-rolls often express the lament: “Lots of them; we’re just waiting on ‘placement’.”
Safely transitioning patients out of the hospital to supportive sites of care remains a jigsaw puzzle of red tape, ineffective communication, archaic payment structures, and unavailable beds. The complexity of these transitions leaves many patients staying in the hospital for prolonged periods — days to weeks or even months — after they have completed their care, adding cost, risk and heartache to many hospitalizations.
As hospital physicians, we see the compelling need for federal investment in home care services to help patients heal where they heal best — at home. President Biden’s original $2.6 trillion infrastructure package contained a bold and thoughtful investment of $400 billion in bolstering home care services. Yet, the watered-down version of the bill passed by the Senate contained exactly zero dollars for home care, let alone any healthcare infrastructure. Now, with the conglomeration of multiple progressive agenda items in the upcoming $3.5 trillion spending bill, highlighting the transformative nature of proposed home healthcare spending is beyond timely.
The bottleneck created at the point of discharge can leave hospital beds filled with patients who do not need to be there, leading to delays in care, overflowing emergency departments and increased risks of infection, falls and other hazards of inpatient stays. One recent study showed that discharge delays can cost our healthcare system hundreds of thousands of dollars per patient. This does not even consider the impact of depression and anxiety on a patient’s recovery trajectory.
One obvious solution to the discharge bottleneck is to equip patients and families to continue post-hospitalization recovery in a patient’s home. We’ve known for a long time that patients who are safe to be discharged do best in their own homes, with the proper support. A recent study in the Journal of the American Medical Association showed that following a knee-replacement, patients do as well heading home after the hospital as they do when discharged to a rehab facility. There are a host of services already in place to provide home care, including home nursing companies, DME (durable medical equipment) providers, and home-based primary care practices (so-called “house call doctors”). Many states and municipalities (including Philadelphia, where we work) provide payment for appropriately trained and supervised family members to act as paid caregivers — all of this in service of the notion that care at home is often cheaper, safer and better than facility-based care.
The administration’s new tax and spending bill includes groundbreaking investments in the infrastructure of home health care. In addition to key investments in drug pricing and Medicaid expansion, this bill stands as an opportunity to redefine the importance of home healthcare as central to American well-being. Lest the process of reconciliation forget.
The case for bolstered home care services for patients leaving the hospital is clear. Investing in these services will allow patients to accelerate their journey through the hospital and make it home faster. It will help hospitals and physicians at the bedside navigate patients along their course towards health. Even further, there are a myriad of positive societal and economic benefits of reimbursing family members who act as caregivers. Investment in family home-caregivers will recognize loved ones who forego jobs, education, or promotions to be there for their loved one as they leave the hospital.
Hospitals and physicians know that transitioning patients who no longer need hospital-level care to their life outside can be agonizing, protracted and at worst dangerous. The Biden administration and Democrats’ inclusion of home-care services into future spending bills will help facilitate improvement of this transition, and will be a step in the right direction towards improving the safety, efficiency, and compassion of America’s healthcare system.
Andrew Becker, MD, MPH is an associate fellow at the Leonard Davis Institute of Health Economics and a resident physician at the University of Pennsylvania.
Jeffrey Jaeger, MD is a senior fellow at the Leonard Davis Institute of Health Economics, professor of Clinical Medicine at the University of Pennsylvania, and serves as the lead physician for the Commonwealth of Pennsylvania’s Regional Response Health Collaboration Program.
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