After Helena Bisio, 98, was admitted to the Brigham for worsening heart failure, she feared she would spend the rest of her life in the hospital. More than anything, she wanted to be back in the comfort of her Roslindale home — relaxing in a cozy recliner and reading on her Kindle.
So, when Bisio’s care team came by her bedside to let her know she was eligible for the Brigham’s Home Hospital program, she was overjoyed to enroll.
“I just lit up,” she said. “The hospital’s good — don’t get me wrong — but your own bed is so much more comfortable. There’s nothing like being at home. Even though you’re sick, you can relax and know somebody’s taking care of you.”
The Home Hospital program provides select, acutely ill patients the opportunity to receive hospital-level care in the comfort of their home. Eligible patients, who must live within 7.5 miles of Brigham and Women’s Faulkner Hospital, can be enrolled via the Brigham’s or BWFH’s Emergency Department, inpatient units and outpatient clinics for issues such as infections and exacerbations of heart failure, asthma, chronic obstructive pulmonary disease and acute pancreatitis.
Discharged in late November after 13 days in the program, Bisio says she’s feeling stronger each day. She lost 20 pounds of fluid from her body, making it easier to move and breathe comfortably. Now, the great-grandmother of five is getting back to doing what she loves: playing Scrabble, connecting with her family and, of course, devouring more e-books on her Kindle. She’s also looking ahead, particularly to the upcoming birth her sixth great-grandchild.
“My experience with the home hospital was marvelous,” she said. “I’m so grateful that they gave me such loving, gentle care and attention. It was a wonderful team. They didn’t hurry anything — they spent so much time with me and didn’t leave until I felt ready. I just cannot say enough about how kind they all were.”
Thanks to recent changes in Medicare and Medicaid reimbursement, the Brigham’s Home Hospital program and others like it around the country are poised to make this type of home-based care accessible to even more patients.
On Nov. 25, the Centers for Medicare and Medicaid Services (CMS) issued a waiver for home hospital services, providing reimbursement for those services, which will allow more hospitals the flexibility to provide acute care services in the comfort of patients’ homes.
Prior to this change, the Brigham’s Home Hospital program was internally funded, which had limited its growth. With this new waiver, Medicare and Medicare will begin covering these services for eligible patients. The Brigham was one of nation’s first institutions to receive this waiver from CMS.
“This is such an exciting development because it is going to expand opportunities in a big way for patients eligible for this kind of care,” said David Levine, MD, MPH, MA, medical director of Strategy and Innovation for the Brigham Health Home Hospital program. “I think we are going to see home hospital programs sprouting up all over the country. It is going to be a huge paradigm shift in how we treat patients.”
Brigham hospitalist Robert Boxer, MD, PhD, medical director of Clinical Operations for the Home Hospital program, praised the waiver as a bold step by CMS that will support the expansion of existing home hospital programs and the development of new programs — bringing this patient- and family-centered care model to many more patients.
“Home Hospital is such an important option for our patients, particularly our older patients, just like Ms. Bisio,” said Boxer, who cared for Bisio during her recent illness. “At home, older patients are much less likely to become confused like they do in the hospital, which often then results in other complications and further deconditioning. At home, patients can move around much more freely than they are in the hospital, where they spend most of the time in bed and subsequently lose functionality they might never regain. Being at home also allows for a patient’s family to participate much more in the decision-making and post-discharge planning, which is particularly important now when hospitals need to restrict visitors.”
Brigham at the Forefront
Brigham faculty have been at the forefront of bringing these changes into effect — presenting their research and helping provide significant input to CMS into the waiver process, inclusion and exclusion criteria, and optimization of quality and safety.
The Nov. 25 announcement came shortly after Levine co-delivered a presentation to the CMS Innovation Center, joining other national leaders in the field to showcase research demonstrating the safety, quality and cost-effectiveness of home hospital care.
Among the evidence that inspired CMS officials to look at creating a waiver for home hospital services was a December 2019 study led by a team of Brigham investigators who conducted the country’s first randomized controlled trial of hospital-level care at home for acutely ill adults. They found that the cost of care was nearly 40 percent lower for patients cared for at home compared to those in the control group, who were admitted to the hospital. Home hospital patients had fewer lab orders, used less imaging and had fewer consultations. The team also found that home hospital patients spent a smaller portion of their day sedentary or lying down and had 70 percent lower readmission rates within 30 days than patients in the control group.
“Our research has shown that we can deliver hospital-level care in our patients’ homes with lower readmission rates, more physical mobility, and a positive patient experience,” Levine said. “During these challenging times, a focus on the home is critical. We are so encouraged that CMS is taking this important step, which will allow hospitals across the country to increase their capacity while delivering the care all patients deserve.”
As for Bisio, she is grateful to have access to a model of care that is both cutting-edge and intimately familiar.
“When I was young, doctors would come and check on us at home when we were sick. Never in my days did I think we would have something like this again,” she said. “It’s an amazing thing for people growing older to receive care in their home, especially now so they don’t have to go out and expose themselves to this awful coronavirus.”
Her daughter, Mary Ann Larocque, also expressed her appreciation for the thoughtful, compassionate and expert care the Home Hospital team provided her family.
“I would recommend this in a heartbeat,” Larocque said. “There are lots of things my mom is hopeful for now, and to see that shine in her face and her heart again — to me, it’s a gift.”