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How House Calls Can Reduce Hospital Readmissions

New Jersey hospital sends medical teams to patients’ homes to coordinate follow-up care

The health care industry abounds with new ideas to reduce unplanned hospital readmissions and emergency department (ED) visits, but a New Jersey hospital has turned to an old-fashioned medical strategy –– the house call.

The Valley Hospital in Ridgewood, New Jersey, launched its Mobile Integrated Healthcare Program in August 2014 to provide “proactive, post-discharge home check-ups” to patients with cardiopulmonary disease who are at high risk for readmission and either declined or didn’t qualify for home care services, according to a statement issued by the facility. In the program, a team composed of a paramedic, an emergency medical technician, and a critical care nurse conducts a physical exam of the patient, offers medication education, reinforces discharge instructions, completes a safety survey of the patient’s home, and confirms that the patient has made a follow-up appointment with a physician.

The program began with patients hospitalized for heart failure because “this population of chronically ill patients, who are generally elderly, have frequent bounce-backs to the hospital, which we know is not good for them,” Robin Giordano, supervisor of the hospital’s Outpatient Transitional Care Program, said. But the hospital has since expanded the program to include patients who have undergone transcatheter aortic valve-replacement procedures because they often have multiple health problems and their postoperative care can be complex, according to the statement.

The Valley Hospital’s program is not the first to advocate proactive efforts to reduce costly readmissions. North Memorial Health System in Minnesota sends community paramedics to patients’ homes to reduce ED readmissions, and other programs go even further, using health outreach workers to connect patients to essential goods and services and to continually manage the patients’ chronic conditions.

The concept of the house call also has made a comeback thanks to health information technology, which allows doctors and emergency personnel to virtually check in on patients, FiercePracticeManagement has reported. But some payers have disputed the value of in-home health assessments of Medicare Advantage patients, arguing that there is little evidence that they do more than raise costs, according to FierceHealthPayerAntiFraud.

Sources: FierceHealthcare; April 23, 2015; Valley Hospital; April 20, 2015; and FierceHealthcare; December 2, 2013.

 

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