Why and How Health Care Is Moving from the Hospital to the Home

Caregivers at UH Home Care Services now number 500

UH Clinical Update - July | 2019

By Cliff Megerian, MD, FACS
President, UH Physician Network and System Institutes

Over the next year, as the upcoming presidential election unfolds, we will be hearing a lot of chatter on television and other media about the need for our nation to reduce its health care costs.

At UH, we certainly are playing our part. Consider this: just a few years ago nearly 70 percent of our revenue from medical care took place in our hospitals, on an inpatient basis. The other 30 percent came from care that was provided at home or in an outpatient ambulatory setting.

As of this year, these percentages are nearly reversed. We as an organization and provider community have realized the value of providing care closer to home, in lower-cost ambulatory settings and outpatient surgical settings, and by delivering a sizeable portion of care to our patients in their homes.

You may not be aware that about eight years ago or so, nearly everyone who had a knee or hip replaced went either to rehab or to a short-term nursing facility. Now, through careful planning, pre-operative preparation and counseling by surgeons and their teams, we send nearly 70 percent of patients directly home from surgery.There’s also been a significant decrease in the hospital stay after these procedures, which is now down to an average of two days and in some cases, even shorter.

None of this would be possible if we had not carefully built a very important segment of our care delivery program – UH Home Care Services, our home health enterprise, led by Brandy Sparkman-Beierle, who is Vice President.

In the past year, UH Home Care has expanded to about 500 caregivers. It should be no surprise that many patients prefer to receive care in the comfort of their own homes. Those suffering from chronic disease, such as congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD) and diabetes make up a large portion of home care patients; wound care and infusions are common services that can be provided at home.

And of course, much research has shown that patients cared for at home instead of in a hospital have a lower risk of infection as well as of falls or other complications.

What has allowed for this growth in home care, at UH and elsewhere? One element is the technological ability that physicians now have to assess and monitor patients who are at home. Also, physical therapists, occupational therapists and speech therapists can easily provide their services in a patient’s home. Home health aides stop by several times a week to provide help with bathing and personal care, as well as to check the home for any hazards that may need to be corrected.

Our UH medically-licensed social workers help patients and their families connect with available and appropriate community resources. Also, all these services also are typically covered by most insurance companies including Medicare, Medicare Advantage, Medicaid and commercial plans.

Astonishingly, we now take care of nearly 4,000 post-acute patients in their homes and within communities that UH serves. This is more than we do at all of our inpatient hospitals combined.

As you can see from the specifics I’ve mentioned above, caring for these patients within the home environment is not done in a cavalier fashion. The team we have grown within the UH health system to provide safe oversight and health care, monitoring and intervention ensures that.

We want to keep patients healthy at home instead of healing in the hospital.

The growth of home care in our system and others across the U.S. has been an important vehicle by which to maximize value and safety for our patients who are vulnerable, either immediately after a discharge from the hospital or in lieu of hospital admission.

By expanding this sector of our business, we enhance our capabilities as an organization and we show both the community and payers, including the federal government, that we are important stewards of the health care dollar.

Making the patient’s home the venue for care delivery, when possible, is obviously far less expensive than the inpatient alternative for that patient.

But most importantly, it is better for our patients.

For more information, or to make referrals, please email uhhomecareintake@uhhospitals.org or call 216-844-4663. Or you can fax 216-360-8948.

To learn more about UH Home Care and the advantages it provides, watch this video.