Bringing Back House Calls: Exploring a Hospital at Home Cancer System

For many patients with cancer, frequent hospital visits — planned or unplanned – can become inconvenient, time-consuming, and costly. Researchers are exploring a Hospital at Home (HaH) oncology care model that would bring much of the cancer care patients receive right to their doorsteps.

Oncology nurses will play a key role in the expansion of HaH, as Nathan Handley, MD, MBA, an assistant professor of medical oncology at the Sidney Kimmel Cancer Center at Thomas Jefferson University, explained in an interview with Oncology Nursing News^®.

HaH cancer models that currently exist in the United States typically include two daily visits from an oncology nurse, and one visit from a physician, in addition to any extra therapy or aid that the patient may need.

“I think a really good example of the role of oncology nurses would be in the world of home delivery of chemotherapy. Chemotherapy that's given either in the inpatient unit or in the outpatient infusion center, a lot of it could be given in the home setting,” Handley said. “Outside of the US, a lot of it is given outside of the hospital setting. Having someone who is trained in that and aware of that would be critical to the success of the program.”

Handley also emphasized that in order to be classified as a true HaH program, the care must meet all of the same quality standards that it would if it were given in an inpatient hospital setting. Additionally, HaH could add another layer to personalized care, as nurses and other providers will better understand the patients’ lives as a whole.

“There's potentially an opportunity for nurses and other care providers to feel that much closer to their patients because they get to know them in a much more intimate setting — in the home setting,” Handley said. “That can provide a lot of insight into some of the challenges that patients face and more insight into what their lives are actually like.”

This can clue healthcare providers in to reasons why patients are missing hospital appointments or not taking their medications regularly.

“It can provide a lot of insight as to why compliance might be an issue, for an example. For nurses and other providers, having that increased level of connection is appealing.”

While HaH has many benefits, there are some hurdles that may be preventing its widespread implementation across the US. Logistically, there must be a very well-oiled system in place to schedule visits and treatments and to match healthcare providers with patients based on location.

HaH presents itself with some financial concerns as well, especially with the nation’s current insurance model. Other countries have much more widely used HaH models, in part thanks to their policies, according to Handley.

“A lot of the countries that have these programs have single-payer systems, so any way that you can reduce total cost of care that basically just goes to the bottom line; there's a lot of incentive to reduce total cost of care. Whereas in the US in our fee-for-service system, that's not really the case. If a major hospital system today, that saw primarily patients with private insurance, were to implement this model, they probably would see a revenue decline almost immediately. There's not really a mechanism by which home care is reimbursed at the same level as hospital-level care,” Handley said.

Depending on how Medicare and other payers decide to reimburse HaH, some American patients may even see higher out-of-pocket expenses by switching over. However, there is hope, as Handley mentioned, that there is a current policy proposed that would limit the amount that patients would have to pay for HaH, ensuring that they would not exceed what they’d be paying in the traditional hospital setting.

“Some of the more progressive payers are going to be increasingly more interested in models like this. I think they also understand that models are not going to succeed if costs to patients are increased,” Handley said. “I think that we're moving in that direction. We're not quite there yet.”