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Top Questions about Hospital at Home

Hospital at Home programs continue launching across the country, boosted by the extension of the CMS Acute Hospital Care at Home waiver and a growing body of data, testimonials, and enthusiasm for the care model.  

Here are some of the top questions asked at a recent AMA (Ask Me Anything) with Deidre Rolli. Deidre is a Clinical Consultant at Current Health, and formerly was instrumental in building the highly successful Hospital at Home program at UMass Memorial Health.  

1. What is the average daily census of Hospital at Home programs participating in the CMS waiver and those that operate without it?  

Programs that operate solely under the CMS waiver tend to have a lower daily census, averaging around 2-3 patients, while those not participating in the waiver or not reliant only on Medicare patients tend to have higher daily census. Most health systems that operate this model outside of the CMS waiver have a health plan associated with their health system, which frees up more eligible patients.  

Deidre advises teams to understand their health system’s patient population and analyze that data to identify opportunities for growth. 

2. What are the top drivers for increasing patient volume in a Hospital at Home program? 

Growing a Hospital at Home program is multifaceted. Deidre recommends marketing the program internally to referring physicians, identifying key departmental champions who support the program, and meeting with case managers, nurse managers, and anyone with control over the patient flow. 

It’s also important to have ongoing visibility in emergency departments, marketing materials around the facility, and to connect with patients and their caregivers at discharge to share success stories. Additionally, providing data on the program’s success, such as reducing readmission rates, can encourage more patients to choose Hospital at Home services. 

3. What is the staffing ratio for nurses and how is it reported on to know if it is adequate?  

Deidre suggests that the staffing ratio for field nurses should be around 3-4:1, depending on how many times the nurses are going into the home, and how far they have to travel. For two visits a day, plan for two hours per patient plus travel time for a 12-hour shift, with admissions and discharges taking about 90 minutes. For virtual nurses, the ratio should be 30:1. But it takes 6 FTEs to staff for the 24/7/365 monitoring that is important for the safety of high acuity programs. 

4. How should Hospital at Home programs manage pharmacy services? 

Most programs rely on their inpatient pharmacy services. Deidre advises teams to work with their pharmacy to determine applicable state laws. For example, some inpatient pharmacies will not compound medications, and some states will not allow narcotics to be dispensed. Build a workflow within your daily operations for medication delivery, dose changes, and lab evaluations with regard to dosing.  

5. What are the important metrics for evaluating a Hospital at Home program? 

The metrics to be tracked will evolve over time, but currently include: 

  • Average length of stay 
  • 30 and 60-day readmissions 
  • Inpatient bed hours saved 
  • Percentage of escalation back to the hospital 
  • Patient race and ethnicity 
  • Mortality 
  • Safety (falls, hospital-acquired infections, pressure ulcers) 
  • Compliance with wearable technology and alarm volume 
March 09, 2023