In this guest post, Jonathan Moody from Physio Inq shares his views on how telehealth can enable an increased number of services and recovery to be conducted in the home – taking pressure away from the already stretched hospital system.
For a long time, integrated care has been the gold standard for healthcare outcomes. Comprising a multidisciplinary team of practitioners who communicate with each other to provide patient-centred services. Integrated care not only offers people the healthcare functions they need but also takes into account the context of their environment and lifestyle.
The results speak for themselves: if you can seamlessly move a patient from a hospital environment and get them home as soon as possible with the same integrated care approach, rehabilitation can be much faster due to the patient recovering in an environment that is meaningful to them. The rehabilitation process should be relevant and purposeful.
Hospital in the Home (HITH) also known as Hospital Substitute Treatment, is a model that works well with integrated care. It’s designed to treat patients with illnesses or conditions that may need close monitoring, but who are not likely to deteriorate rapidly, so they can undergo the recovery process at home. This minimises disruption to their lifestyle and enables hospital beds to be used for more serious cases.
During HITH, specialists and Allied Health professionals that provide service inside hospitals can also service patients in their homes. There are some challenges with this model, including costs that need to factor in things like travel time, which means practitioners see fewer patients.
Conversely though, moving a patient out of the hospital helps to free up much-needed beds – taking that person off the hospital’s ledger and improving the bottom line of the facility. However, in many cases, the patient or their insurer is required to meet those costs, which in the short term discourages the adoption of this model. There needs to be a rethink of the value proposition from insurers to move toward a new inpatient and outpatient cost coverage.
Pairing telehealth with HITH
Telehealth can assist in cases where patients need monitoring but don’t necessarily require in-person care. The continuing advancement of technology means tools like Bluetooth-enabled monitoring devices may be used to share data with the practitioner about the patient. With the patient being in their own home, the treatment can also be tailored to that context rather than a clinical environment, which often doesn’t present an accurate picture of how the patient is tracking on a daily basis.
Telehealth is, of course, cheaper than travelling practitioners, but not a one-size-fits-all solution. I see good use of telehealth and HITH in situations as an adjunct for recovery from conditions that have may be a standard rehabilitation protocol where the patient is charged with administering much of the therapy, but the practitioner is required to ensure compliance. Factors, such as having a lower infection risk when the patient is treated out of the hospital, support that position.
What COVID-19 and the emergence of telehealth technology and practices have taught us is that many telehealth treatments are very effective and I’m hoping the momentum from this carries through to the uptake of HITH in tandem.
Redesigning the healthcare system
The unfortunate part of all this is that despite the obvious benefits of pairing telehealth and HITH, we have a healthcare system that is very much focused on hospital-based treatment, with the bulk of the public health budget going towards building and maintaining an overhead heavy system without regard for more targeted outpatient care.
An inpatient’s care is generally covered by Medicare, a health insurer or a combination of both, but once at home, if the healthcare provider is not on board with HITH or telehealth, then the patient faces significant out-of-pocket expenses.
The other consideration is that hospitals are a hub of medical practitioners, they concentrate specialists and doctors that are involved in a particular type of treatment in one place. If we were able to deploy these practitioners efficiently under HITH, we could reduce hospitals to a quarter of the size – a hospital may cost $2- $3 billion to build for not that many beds in relative terms – that money could be better spent on supporting the required workforce under a HITH model that would treat more people.
In the end, I believe we will require a tripartite solution between the public healthcare system, private health insurers and health practitioners. Investing in home-based healthcare models takes effort and we may need as much evidence as possible to prove its efficacy before we attract more interest to overhaul this area.
