MetroHealth’s ‘Hospital-at-Home’ Vision May Soon Move Even Inpatient or Critical Care Care to a Virtual Model


CLEVELAND, Ohio – The COVID-19 pandemic has forced hospitals across the United States to adapt a telehealth model to treat patients at home. MetroHealth seeks to make this change permanent with a bold new vision that could see everything from outpatient services to inpatient care for patients who never have to leave their homes.

The model presented by MetroHealth at its annual stakeholder meeting on Thursday is different from the “home hospital” programs offered at other US hospitals. MetroHealth is looking to reinvent traditional healthcare delivery, President and CEO Dr Akram Boutros said in an interview with editors and reporters at and The Plain Dealer.

“This is not an evolutionary approach to virtual care or telemedicine. It’s revolutionary. We are designing it from scratch, ”Boutros said at the meeting. “We put aside the traditional system and start from scratch. “

What would distinguish the MetroHealth model, which will be rolled out in 2022, is that it focuses on the entire continuum of care for a patient, said executive vice president and director of clinical healthcare system transformation , Dr. Nabil Chehade in an interview.

In practice, this would mean that a patient’s primary care visits would be virtual and they would have access to wellness services to stay healthy. If they need an x-ray or a blood test, a nurse or technician from MetroHealth could come to the patient’s home to save them a trip to the hospital, Chehade said.

Some patients might even receive hospital care at home, Chehade and Boutros said. For example, a patient who receives hip replacement surgery might recover at home rather than in the hospital. MetroHealth doctors and nurses could monitor patients to see if they are moving enough or if they are doing physiotherapy.

If the patient’s vital signs show that a problem is occurring – such as if the patient develops a blood clot – MetroHealth could send a team of doctors and nurses to treat the patient and stay with them until they are stable. .

“It’s not for everything, of course. We don’t do home surgeries, ”Chehade said. “But a patient could access an increasingly acute level of care when they need it and stay home.”

MetroHealth also sees other benefits in home care for patients. Studies have shown that “home hospital” programs can reduce health care costs, prevent infections, and improve patient outcomes.

MetroHealth thinks even bigger for its long term goal for the program. Within five years, the healthcare system is looking to expand the program to critical care patients with long-term conditions, such as chronic heart disease or sepsis, Boutros said in a meeting with cleveland. com and The Plain Dealer.

“Some things cannot happen. But there are other things that can. Chronic medical diseases – heart failure, COPD, kidney failure, sepsis – all of these things can be done, ”Boutros said at the meeting.

Accelerated by COVID-19

MetroHealth has been mulling the idea of ​​a “home hospital” program for several years, but the plan has shifted into high gear during the COVID-19 pandemic. To protect patients from contracting COVID in hospitals, the healthcare system has moved many of its services remotely.

In addition, MetroHealth has offered home monitoring used to provide hospital care for around 700 patients during the pandemic, Chehade said. The majority of these patients had COVID-19, but the symptoms were not severe enough to warrant a hospital stay.

The success of remote home monitoring of patients has made decision-makers at MetroHealth clear that they could act a little faster to embrace some of their long-term goals.

“[The pandemic] pushed us to accelerate this innovation, ”said Chehade. “It made us understand that it’s not in 20 years. The first steps can be taken safely now.

MetroHealth already has the infrastructure in place to begin the transition, as it was used to treat 700 patients at home during the pandemic, Chehade said. Patients receive basic medical equipment, such as blood pressure monitors, as well as Apple iPads already connected to a 4G LTE connection paid for by MetroHealth. Teams of doctors and nurses monitor patients 24/7 and will be ready to respond to any issues or call an ambulance in an emergency.

The idea of ​​a “hospital-at-home” program has been thrown around for decades, at least in a more limited capacity. Dr Bruce Lee of Johns Hopkins University developed a model a quarter of a century ago after noticing that many of his geriatric patients performed worse when admitted to hospital.

Presbyterian Healthcare Services of New Mexico launched its Hospital at Home program in 2008, providing inpatient care stable enough to be treated at home.

However, these types of programs struggled to gain traction as they were not eligible for reimbursement by Medicare and other health insurance plans.

That started to change in late 2020, when the Centers for Medicare and Medicaid Service launched a new program to expand eligibility for “hospital-at-home” programs. The new program covers more than 60 medical conditions, including asthma, chronic obstructive pulmonary disease, congestive heart failure and pneumonia.

Boutros said MetroHealth’s program should also be covered by Medicare and other health insurance.

It is also likely that the cost to a patient will be cheaper through a “home hospital” model, Boutros said. Israeli hospitals that used a similar approach found that home care was half the cost of traditional hospitalization.

Overall, the benefits of moving to a “hospital-at-home” approach to health care are clear to MetroHealth, said Chehade.

“Healthcare is evolving and we understand that we need to take advantage of technology, like all other industries, in order to provide better care and more accessible care at a lower cost,” he said.

And after?

MetroHealth has already developed a platform for its program. The healthcare system is now forming a business designed to provide healthcare to all patients who are stable enough to stay at home instead of being admitted to a hospital.

The healthcare system is also looking for five to six healthcare and technology partners to help them scale the program to the point where it could be offered nationally, Boutros said at the meeting.

It’s unclear how much it will cost to roll out the model in Greater Cleveland or expand it nationally, although Boutros estimated the latter effort could cost $ 500 million. However, a very large part of that cost could be paid by investors, such as tech companies, he said.

The whole “hospital-at-home” program will not be ready from the start. It will be implemented in waves, as the hospital becomes more comfortable with monitoring various types of patients at home, Chehade said.

“As we refine our protocols and are able to call on a multidisciplinary team to care for the patient remotely and at home, this level of care will begin to intensify,” he said. declared.

Ultimately, however, Chehade believes 30 to 50 percent of non-surgical hospital patients on regular medical floors could be monitored at home. And in three to five years, about 80% of outpatient visits could be online or at home, he said.

Boutros told editors and reporters at and The Plain Dealer that MetroHealth sees this effort as a step towards fulfilling the promise of making healthcare more patient-centered. Many hospitals have touted this goal, but patients are still encouraged to make an appointment and come to an appointment. Bringing services to a patient at home would be a truly “patient-centered” approach to healthcare, Boutros said.

“[What] we’re saying we’re going to keep the promise of patient-centered care, ”he said at the meeting.


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