Promoting Length of Stay Reduction and Readmission Avoidance

Medical home is a concept that is being embraced more and more in the healthcare field. As defined by the Agency for Health Care Research and Quality, a medical home is “not simply a place but a model of primary care that delivers care that is patient-centered, comprehensive, coordinated, accessible, and continuously improved through a systems-based approach to quality and safety.” Home infusion therapy – the administration of IV or other related treatments in the home – fully supports this concept of the medical home. And it uses this concept, in the form of careful care transition and collaborative, interdisciplinary care paired with an alternate site of care model, to support two key goals of the healthcare community at large: hospital length of stay reduction and readmission avoidance.

This article will explain the background of these two goals and present a patient case example highlighting how home infusion embraces the concepts of the medical home, supports these two important goals, and helps promote patient care and care outcomes, all while reducing total cost of care.

Length of Stay Reduction

Hospital length of stay has a big impact on a patient’s healthcare experience, as well as on the cost of care and the risk of hospital-acquired health problems. Increased length of stay may be caused by medical complications, or the need for care thought to require inpatient status. Even when the patient is ultimately determined to be ready for discharge, other barriers may stand in the way of the patient’s transition to home, including verification of insurance benefits, the need for central line placement, or even lack of transportation.

A primary reason for reducing length of stay is that earlier discharge to the home is associated with decreased risk of hospital-acquired conditions (HACs). HACs not only risk patient health, they also account for one in six reimbursement claims, according to 2008 Hospital Professional and Physician Liability Benchmark Analysis, and add anywhere from $28B to $45B to U.S. hospital costs annually. And they recently became even more expensive – on July 1, 2011, state Medicaid programs were slated to begin denying payments to providers for costs associated with treating HACs. In addition, in 2015, Medicare is scheduled to reduce by one percent its payments to certain hospitals for HACS.

An Alternate Site of Care

Home infusion therapy presents the option of an alternate site of care to reduce length of stay in the acute care setting. Transition of care from the hospital to the home has many benefits, including reduced risk of HACs, improved patient quality of life, and reduced cost to the patient and healthcare system. In addition, the reduction in length of stay can free beds for patients in busy hospital systems.

To make our alternate site of care plan work, we need to make sure our patients receive their infusion therapy safely and effectively in the home. Once the patient has been transferred home, we provide care following clinical pathways and evidence-based care management guidelines. Patient-specific education, home follow-up and on-site assessment are performed by a registered nurse and other clinical team members, such as a pharmacist and dietitian. Our clinical team monitors the patient’s response to therapy and the patient is provided clinical support 24/7 throughout the course of therapy. Finally, a careful outcomes analysis is conducted. Our outcomes have shown that home infusion’s alternate site of care approach provides increased patient convenience and comfort as well as improved patient adherence to therapy.