Stakeholders praise implementation success of Florida hospital at-home program
On Jan. 17th, Florida’s Senate Committee on Health Policy received a presentation about the successes of Senate Bill 1222 as it relates to acute and post-acute hospital care in the home setting. The bill passed last summer.
Under SB 1222, hospital pharmacies are authorized to dispense medications to hospital-at-home patients, and authorized paramedics to provide in-home visits under the supervision of a physician. Hospital-at-home programs in Florida are available at the Cleveland Clinic, Health First, Keralty Hospital, Mayo Clinic, Orlando Health, and Tampa General Hospital.
While the traditional hospital setting requires expertise, technology, and care delivery models, the hospital-at-home setting provides patients with comfort, convenience, control, and freedom, in addition to expertise, technology, and care delivery models. According to the presentation, issues with hospitalization include unintended adverse clinical events, such as delirium, weakness, and infections. Further issues with hospitalization include hospital bed capacity and soaring costs.
Michael Maniaci, MD, who is the medical director of the Mayo Clinic Hospital in Florida, mentioned how the hospital-at-home setting allows patients to recover faster and drives down healthcare costs.
“Telehealth plays a key role,” Maniaci said. “It’s both the virtual connection: physically being able to jump in the home, the response time of our nurses when the patient pushes a button—less than 30 seconds.”
Maniaci described the telehealth care aspect of hospital-at-home to be instantaneous. Facilities offering the program provide patients with an in-home technology package which includes biometric monitoring, such as a blood pressure cuff, a pulse oximeter, a thermometer, and a scale.
“The first thing we utilize is a sensor that sits on the chest that sends biometrics to us every five seconds for blood pressure, heart rate, temperature, and oxygen level,” Vice President of Healthcare Design Peter Chang said.
Patients are also provided with a telephone, a tablet, and cellular and Wi-Fi-enabled internet to ensure access to telehealth services, which include 24/7 on-demand staff, who can reach out to the patient if their biometrics are off, or who the patient and their families can contact when needed.
The hospital-at-home program includes two daily in-home visits from traveling registered nurses and community paramedics under the supervision of the Command Center. Every patient’s homes are assessed for safety concerns, including fall risk, fire safety, and medication storage. Patients are educated on when to contact emergency services and their care team. Medication administration is conducted by a Mayo Clinic registered nurse through video and is documented in the medical record.
Incorporating this model throughout the state of Florida allows brick-and-mortar hospital beds to be used for acute or unstable patients, and places less strain on the dwindling medical field workforce.
“How do you apply human resources to this?” Sen. Rosalind Osgood (D – Broward) asked. “If we have a major shortage of nurses, and different things we talked a little bit through that piece. Do you ever lose people because they go to other states to be paid better wages?”
Maniaci brought up how 40% of nursing consists of bedside care, with 30% of nursing consisting of knowledge in the brain and the remainder consisting of actions they should not be doing.
“You’re right,” Maniaci said. “We’re at a critical shortage of nurses, and by the waiver and what we need to do and what’s right for the patients, you need two physical touches at least a day in the home-hospital.”
Maniaci emphasized how nurses who can no longer practice medicine on the floor due to age or disability are now able to continue practicing virtually through this program.
“I think virtual care is going to save nursing in the future, both in hospitals-at-home, but also in physical hospitals as well,” Maniaci said.
For the program at the Mayo Clinic, there were over 1,700 admissions; over 6,400 hospital beds saved for highly acute patients; and 92% of patients responded as highly likely to recommend the program.
Going forward, CMS will conduct studies on the efficacy, safety, and cost of at-home-hospitalization. The federal waiver for this program is active until Dec. 31st, 2024, which CMS and Agency for Health Care Administration waivers are linked to. To make the program permanent, federal and state legislation needs to be enacted.