Opinion

Hospital-at-home system: How the risk outweighs the perceived benefit

An entire reform of the medical education system is necessary.
<a href="https://highschool.latimes.com/author/abbychangg/" target="_self">Abby Chang</a>

Abby Chang

June 24, 2022
[This article is a response to a piece published by Rob Rohatsch about the future of hospital care and, specifically, the hospital-at-home system and telemedicine. I attempt to analyze and reconcile the benefits and disadvantages of shifting to a future that Rohatsch proposes.]

Humans are at the cusp of technological innovation that can revolutionize not only cars and phones but healthcare. During COVID-19, the use of telemedicine in relaying information testifies to the promising future of the intersection between medicine and technology.

America is notorious for its pricey healthcare that only lends its benefits to those who are privileged with health insurance. The privilege of health insurance, hospital stays, medication and treatment easily rack up in costs. Not only is hospital care expensive, but also counterintuitively unsafe.

Antibiotic resistance that exists in the hospital setting is detrimental to people’s livelihood and can cause extended periods of hospital stay. Furthermore, the healthcare industry revolves around the idea of “value-based care,” according to Rob Rohatsch of STAT.

In essence, Rohatsch argues that doctors and physicians make money based on the outcomes of the patient after their care, which ultimately results in turning down patients who actually direly need hospital care. Thus, the article proposes that healthcare goes through a revolutionary reform, one that brings hospital-level treatments to the enclosures of humanity. This shift, from hospital building to home, possesses many economic and health benefits if said obstacles are mitigated.

The “Hospital-at-Home” model was first postulated by Dr. John Burton of Johns Hopkins and Dr. Donna Regenstreif of John A. Hartford Foundation back in 1995. In the same hospital-at-home study, they performed research on elderly patients with community-acquired pneumonia, chronic heart failure, chronic obstructive pulmonary diseases or cellulitis, it concluded that not only do patients prefer hospital-at-home care over acute hospital care 69% of the time, but their length of stay and mean costs for treatment decreased as well.

The Commonwealth Fund reports that the average length of stay shortened to 3.2 vs 4.9 days and the mean costs were around $5801 in comparison to $7480 in-hospital care. A transition to include hospital-at-home as a treatment option can diminish the risks of healthcare-related bankruptcy and be less economically taxing to the patient. 

Additionally, patients can avoid going to the hospital and prevent antibiotic resistance that may hinder their recovery process. Another study performed by Johns Hopkins compared 323 patients with congestive heart failure, cellulitis, deep vein thrombosis, pulmonary embolism, urinary tract infection, nausea, vomiting or dehydration who chose hospital-at-home with 1,048 hospital inpatients.

Patients who chose the hospital-at-home care received daily visits by physicians and nurses who coached them on how to manage their medical condition as well as administering necessary medication, infusions and other medical procedures. The Johns Hopkins study concluded that patients who underwent the hospital-at-home approach had lower readmission rates and mortality rates, as well as a 10% higher satisfaction score. In short, hospital-at-home have genuine health benefits and a promising treatment plan for the future. 

From the outset, Telemedicine seems to have many benefits, since patients can receive care in the comfort of their homes. It also eliminates potential hindrances such as needing to miss work or harsh travel costs if the hospital is far away.

Furthermore, a study performed by Penn medicine states that even the costs of necessary technology implementation for telemedicine are “nominal,” especially for large hospitals. Also, in the same study, since patients are treated at home, telemedicine allows for reduced facility-related expenses.

However, even if telemedicine appears to be cost-efficient, many other factors may increase the holistic cost. When people increase their usage of telemedicine, there is a -0.8% on the bottom line or the company’s earnings, according to Penn Medicine. For every certain amount of savings due to telemedicine, there is a subsequent negative cost, or expense, that increases as the savings increase. This blurs the lines as to whether telemedicine on a large scale does indeed increase savings for hospitals over the long term.

Nonetheless, many other studies need to be performed in order to concretely determine the benefits of such hospital care. For now, hospitals should remain to offer telemedicine or hospital-at-home care as a potential treatment option for minor health issues. Hospitals that hope to provide home care, in the form of acute hospital-at-home care or telemedicine, as a potential treatment have to overcome a few obstacles to ensure proper care for their patients.

The article by Rob Rohatsch outlines a few setbacks including that patients must be able to access their medical records externally, physicians need to achieve the Goldilocks principle of healthcare along with maintaining value-based care, and finally, doctors must relearn who should receive hospital-at-home care, telemedicine or can be discharged. 

Ultimately, there simply has not been enough research to show how well the system works and we can only estimate the cost and savings based on models. With the current research performed on the status quo, what we do know is that the hospital-at-home system is incredibly difficult to maintain and the bigger we expand this system, the more risk is involved.

The creation of an entirely new “hospital-at-home” and telemedicine treatment plan would be incredibly expensive and also unfeasible at this time. Additionally, if the system grows and becomes a genuine treatment choice, many new risks will arise.

The previously mentioned study explains how there is a negative cost for every increased usage of telemedicine. Therefore, the parallel rise between expense and savings of telemedicine would potentially make it more expensive for the user.

Further, an entire reform of the medical education system is necessary. Doctors, physicians and nurses will need to be retrained to provide this sort of treatment.

Among patients, many elders lack the knowledge and physical ability to use the internet and give themselves care. Therefore, a switch to this system will open up a Pandora’s Box of new obstacles and unknowns.

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