As hospitals nationwide grapple with overcrowding, NYU Langone Hospital—Long Island is on the forefront of an innovative solution. The idea is deceptively simple: Help a subset of patients who would otherwise be hospitalized receive inpatient care at home. But delivering the highest quality of acute care to patients in the comfort of their own home without compromising safety demands an extraordinary level of expertise, and NYU Langone Hospital—Long Island, part of one of the top academic health systems in the nation, is uniquely qualified to set the standard.
In September 2021, its pilot program, called the Home Hospital Program, rolled out with an initial capacity of four patients after earning speedy approval from the Centers for Medicare and Medicaid Services (CMS). The government agency launched the regulatory framework for providing care to patients outside a traditional hospital in 2020 amid skyrocketing cases of COVID. Joseph J. Greco, MD, executive vice president and chief of hospital operations at NYU Langone Hospital—Long Island, and Eve Dorfman, vice president of home health and hospital medicine services, were quick to seize on the opportunity and began crafting a unique approach, and one that would deliver value even as the pandemic subsided.
At NYU Langone Hospital—Long Island, patients with a Medicare health plan who visit the Emergency Department with acute but stable conditions—things like pneumonia, cellulitis, or dehydration—are evaluated by Emergency Department doctors and a nurse for enrollment in the Home Hospital Program. Those who qualify must live within 30 minutes of the hospital and meet a series of other criteria. “We make sure patients are independent or have a dedicated caregiver, that they have heat and electricity, and that their home has safety measures in place,” says Dorfman.
Unlike most other programs, NYU Langone Hospital—Long Island has tapped its own physicians and nurses to build the program and manage patient care rather than outsourcing staff to a third party. Each patient enrolled in the Home Hospital Program receives a tablet for conducting video visits and a wearable device that tracks vital functions like pulse rate, oxygen saturation, and temperature, and transmits the data in real time to the program’s command center, which can coordinate streamlined access to NYU Langone physicians, nurses, and specialty consultations 24 hours a day ,7 days a week. A hospitalist meets remotely or in person with each patient daily, and a field nurse visits at least twice daily to provide hands-on care. “We have the resources and expertise to deliver the same high standard of care patients receive in the brick-and-mortar hospital,” says Christopher G. Caspers, MD, medical director of the Home Hospital Program.
The concept of a “hospital without walls” was first trialed by Johns Hopkins more than two decades ago, leveraging philanthropic support since the approach wasn’t covered by medical insurers. Results from this and other pilot studies have been promising. Data from the Agency for Healthcare Research and Quality, charged with improving the safety and quality of healthcare, show that the model results in better survival rates and fewer infections and readmissions compared with inpatient hospital stays.
Now that the CMS has provided a waiver for coverage—likely to become permanent—and approved more than 200 programs, the model is certain to grow. NYU Langone Hospital—Long Island plans to double the number of patients in the Home Hospital Program by 2024, and discussions are under way to replicate the model at other NYU Langone inpatient locations.
Faith Lynch, DNP, RN, director of acute and home dialysis services, who oversees the program’s nurses, says patients have been highly receptive to the hybrid care model, with more than 60 so far choosing to recover at home. “We’re providing the same care that patients would receive in the hospital, but they can eat their own food, sleep in their own bed, use their own bathroom and shower,” she explains. “Plus, you have unlimited visiting hours.”