Originally published in Becker’s Hospital Review

By Daniel Greenleaf 

As the healthcare business shifts from a fee-for-service model to one where healthcare providers are rewarded for improved patient outcomes, hospitals face a unique set of challenges — they have to please everyone from the Centers for Medicare & Medicaid Services, commercial insurance companies and patients, all while having to cut as much as 30% of their costs to remain profitable.

Many hospitals are responding to these mounting pressures on their traditional economic and operating models of care, by singularly focusing on their core competency — delivering healthcare services for acute conditions and surgical interventions. That means that a growing number of hospitals are forming partnerships to handle care in those areas outside their competency. Among those areas are home infusion services, used to treat patients with a wide range of acute and chronic conditions, ranging from bacterial infections to such things as late-stage heart failure and immune deficiencies.

Here are five benefits of patients receiving infusion services at home rather than at a hospital:

1. Reduced Episodic and Annual Total Cost of Care– The goal of health care delivery is improving the value delivered to patients, measured as patient outcomes achieved per dollar expended. Receiving infusion therapy in the home has significant cost savings compared to in institutional settings, such as hospitals. Per day savings can be up to 90%, with course of treatment savings from $2,000 to $3,000. Typically, patients are responsible for 20% of the total cost of the therapy, so the site of care has a profound impact on the patients’ ability to pay their portion of the cost. Studies show higher out-of-pocket costs reduce a patient’s likelihood of staying compliant with their medications, which results in an increase in hospitalizations and higher health care costs overall. Moreover, patients want lower prices—a recent Kaiser Family Foundation poll reveals that lowering the cost of health care (insurance premiums and out-of-pocket costs) is most important for 67 percent of people. Site of care optimization is often the largest savings opportunity to reduce those costs.
2. Safety– Prolonged hospital stays are a risk factor for hospital-acquired infections (HAI). Approximately 1 of every 25 hospitalized patients in the United States has an HAI, and more than one million HAIs occur across the U.S. healthcare system annually. These infections can lead to significant morbidity and mortality, with tens of thousands of lives lost each year, not to mention a cost of billions of dollars annually. Most infusion patients are immunocompromised and are at greater risk for infection, so avoiding a prolonged hospital stay is important, especially since the risk of contracting an infection is greater in crowed places like hospitals than in the home.
3. Patient Preference– Patients prefer to receive their infusions in the comforts and convenience of their own home. Too often, patient preference about how and where to receive care are not given serious consideration and in some cases patients were unaware they could receive care in the home. A recent study published in the International Journal of Nursing Studies showed that 86 percent of patients prefer being treated at home rather than in a hospital setting. And, according to the Commonwealth Fund, hospital-at-home programs reduce complications and cut the cost of care by 30 percent or more.
4. Reducing Avoidable Readmission Rates– One of the most common reasons for the readmission of patients within 30 days of discharge from a hospital, is a lack of understanding of their treatment regimen. Home infusion providers employ a coordinated team approach that actively manages patient needs to keep them out of the hospital, using clinical liaisons to facilitate patient’s transition back to their homes. This approach allows for improved outcomes for the patient and overall reduced costs for the Health Plans and members.
5. Hospital Financial Performance– Reducing hospitalization rates is a key to controlling health-care costs. Studies show that a significant proportion of acute hospital admissions are avoidable, and many hospitals have introduced initiatives to avoid unnecessary admissions, including using outpatient care when it is available and suitable. Hospitals measure the costliness of a particular patient population using Case Mix Indexes (CMI), reflecting patients’ relative costs. A hospital with a CMI greater than 1, makes a profit on each patient while one with a number below 1 loses money per patient. Typically, the CMI associated with infusion therapy is below 1. Hospitals that work closely with home infusion providers can improve efficiencies, squeezing as much waste out of their processes as possible, while improving quality.

Healthcare reform encourages fresh thinking and approaches to delivering care efficiently and effectively. As hospitals continue to face increasing pressure to reduce costs, one way to accomplish this goal is to better align with post-acute care providers.

Daniel E. Greenleaf is president and chief executive officer of BioScrip Inc., a provider of infusion and home healthcare management solutions.