Blogfinger

Paul Goldfinger, MD, FACC.

I may be behind the medical times in some ways, but I know what  quality medical practice is:

Were you ever admitted to a hospital  “emergency room”  where you found a chaotic setting and no hospital beds.  Perhaps you found yourself stuck on a gurney and pressed against a wall, uncomfortable, uninformed  and without personal attention for many hours? . Did they try to make you comfortable and knowledgeable?

Did any MD’s come to assess your medical situation?  Or were “residents”  of dubious quality showing up without  proper identification and without insight into your medical situation?   Did you have any say in who would be your attending physician ?  Who on the staff understood  the complexities of your case?

Did you feel confident in your care?  Was the ER physician staff attentive, or did they run around understaffed in some sort of Brownian motion?

How about the nurses: Dut did they offer any  personal attention; or only walk  around wheeling a robotic  computer while they clicked off boxes on their check lists?   Did they offer you any personal attention?

Were you left in a corridor or other congested stifling area ?  Did they leave you in an area with bright lights and noise?  Could you sleep?

Did anyone explain your diagnosis and plan of diagnosis and treatment?  Did anyone review imaging and other test results?

How about explain blood pressure and cardiac monitoring goals?

Did anyone explain medications to the patient?  Does the staff really know your  history,  including precise drug doses. Are they capable of thinking for themselves while you beg for pain relief, thirst or some food?    Is there a chair for whoever who is with you? 

If you have a specific  medical issue which might need a specialized consultant, how long did it take for that specialist to show up?    Did it take hours or even days?   Did you receive a choice regarding which consulting doctors would see you?

If you needed  a procedure was it done in a sterile, private,  and well equipped setting?

Did the staff make an effort to have a health advocate readily available to you?

Did it occur to you that you might have received better care at home? 

Consider this: Medicare is developing “Hospital at Home Care”  where patients can go home and receive” hospital level care in patients’ homes as a substitute for care traditionally provided in brick -and-mortatr hospitals.”

AI tells us:

Hospital care at home (or “Hospital from Home”) allows eligible patients requiring acute, inpatient-level care—such as treatments for infections, heart failure, or COPD—to receive professional medical treatment, daily nursing visits, and 24/7 remote monitoring safely inside their own residence instead of a traditional hospital room—if one was even available?

HaH  care was first developed at the time of Covid. “HaH is associated with lower rates of hospital associated complications, better patient care experience, lower postacute health service utilization, and lower costs.”

“HaH care was associated with excellent patient outcomes and high program integrity trained”

“For such programs  trained doctors and personnel  for  in home-based acute care is required.”

This review  is from the Journal of the American Medical Association 5/26/26 and is entitled “Hospital at Home and Transforming US Health Care Delivery.”

In a CMS report to Congress, “HaH care was associated with excellent patient outcomes and high program integrity.”

“Special training and equipment is required for this at all levels of performance such as nursing, hospitalists, pharmacies, para medics, technology, regulations, financing, etc.    

The authors of the paper, mostly from Johns Hopkins say, “HaH–along with societal shifts, in consumer attitudes and use of online retouches, telemedicine, and consumer oriented wearable medical devices–presents an opportunity to reimagine care delivery in a distributed, highly coordinated, truly patient centered care ecosystem in patients homes.

“Frail older adults, especially those who are homebound and who experience preventable hospitalization, are an appropriate initial target population for this ecosystem .  Wow! “Ecosystem”

“While brick and mortar hospitals remain necessary, what we treat in those facilities has evolved over time. The hospital of the future will comprise emergency departments, operating rooms, intensive care, and other highly specialized units. Much else can and should move to the home. HaH can lead us toward this future.”

When it comes to being discharged, did they shuttle you off to some crummy inpatient rehab facility or did they give you an option, such as rehab at home?   There’s lots of money in such services!  Medicare must wake up!!

Editor’s note:  I am a double board certified physician, now retired, who became an expert in acute medical care in hospital ER’s and med-surgeries floors.   These days when I interact with the acute care system locally on the patient side, I consistently find faults which can endanger a patient’s life.  This JAMA article shines an exciting and new light on such care—HaH is growing, and hopefully we will see it implemented where we live.

And don’t get me going regarding the outrageous increase in the use of physician  assistants.  The AMA is waging war on this.

HaH is a thrilling and sensible concept, and I expect to learn more as time goes by.

PAUL ROBESON.    “Shenandoah”

It gives you goosebumps–does it not?

As a doctor I react like this when a medical advance appears. I remember when I was walking on Madison Avenue one morning near Mt. Sinai.  I saw a headline proclaim the first heart transplant . Given the potential impact of HaH, I feel the same way.

PG