Although hospital in the home (HITH) is now a well-established model of care, its definition remains relatively broad and ambiguous.
In some HITH models, patients are initially required to attend a bricks and mortar hospital, with their care continued remotely upon discharge, or beyond a certain stage of treatment.
In others, the entire end-to-end patient journey is managed virtually.
Chief Executive of Calvary Amplar Health Care JV, Sarah McRae, believes it may be time for a definition to be firmed up and for funding models to address this distinction adequately.
“Hospital in the home is often thought of as a single model of care, when in fact it is more like a continuum,” she said.
“At the top end, you have fully-fledged virtual hospitals that provide that 24/7 medical oversight, and which are funded in line with their bricks and mortar equivalent.
“On the other end, you have hospitals that are part of a broader ecosystem and provide only select treatments in the home. Although fundamentally different, they are often funded in exactly the same way as fully virtual hospitals.”
While Ms McRae recognises that each version of HITH has its place in our healthcare system, she believes this point of difference matters from a funding perspective.
“Generally speaking, virtual hospitals can be run more efficiently than a bricks and mortar hospital. You don’t have extra costs from infrastructure and the hotel-like expense around caring for someone in bed.
“I believe we need a more refined funding mechanism that reflects this and recognises the difference between care continuation following discharge, versus end-to-end virtual treatment. Ideally what we should be creating is our own episodes of care and payment structures to align with what is offered via out of home hospital care.”
While the funding surrounding HITH is already a hot political topic, Ms McRae believes progress towards an agreed definition is being halted by the lack of consistency between jurisdictions.
“There are some states that subscribe to the belief that because their HITH programs are run out of hospitals, they should be paid the same as if running from a hospital; whereas other jurisdictions take a different approach.”
Political pressure to open more beds may also be stunting progress towards a more ubiquitous HITH offering, she argued.
“There is this drive to cut red ribbon, as opposed to investing in out of home hospital services that have the agility and flexibility to scale rapidly as required.”
Compounding this are budgetary restraints among local health networks and districts.
“It is hard when budgets are finite and, seemingly, the only feasible way to expand HITH services is by closing beds. Obviously that isn’t an option when you ED admissions are ramping up. You really need an injection of funding to move forward.”
Despite the issues around funding, Ms McRae believes there are ways in which healthcare providers can expand their HITH offering.
“We could further explore opportunities in planned care – for example, focussing on day procedures and reducing the length of hospital stay for surgical patients. With the right preparatory work done virtually, there could be no need for people to be admitted the day before their procedure.
They could just present on the day. Their care upon discharge could also be done virtually.”
Talking more about this issue and sharing her views on how innovation and good governance can help, Sarah McRae will address the upcoming Hospital in the Home Conference, by Informa Connect.
The conference is one of three to be delivered at Connect Virtual Care on 7-8 March 2024 at the Hilton Sydney.
Co-located at the event are the National Telehealth Conference 2024 and the Medication Safety & Efficiency Conference 2024.
Learn more and register your place here.
About Sarah McRae
Sarah McRae is the Chief Executive Officer at Calvary Amplar Health Joint Venture, where she has overseen the full accreditation of their Virtual Hospital, against NSQHS Standards, as one of the first in Australia.
She is a known Executive in Health, having worked as Executive of Strategy at the Southern Adelaide Local Health Network and Chief Operating Officer at Women’s and Children’s Health Network, prior to joining the private sector.
Sarah is known as a change champion and has successfully led large-scale strategic, operational and financial improvements to deliver new and innovative initiatives. Her experience working in both public and private healthcare sectors enables her to successfully navigate the current eco-system of health care.