Utah Huntsman Cancer Institute calls for easing of home-based hospital care

The University of Utah Health (U of U) Huntsman Cancer Institute’s Huntsman at Home (HH) program has been providing a full spectrum of care to acutely ill cancer patients in the home setting since 2018. 

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HH administrators say during the course of their treatment, oncological patients are more likely to develop acute symptoms that require hospitalization and emergency room visits. The home care program focuses on providing prevention and comfort to patients to mitigate this.

Incorporating the CMS hospital care at home model, the program aims to improve the experiences of cancer patients by managing acute conditions that would normally be treated in the hospital through coordinated care at home. To date, HH has taken care of over 2,000 families, mostly in the Salt Lake region. 

In results published last year, researchers found that the program had reduced hospitalizations and emergency department utilization by 55% and 45%, respectively, while reducing overall costs by 47% and length of hospital stay by an average of 1.1 days over a 15-month period from August 2018 to October 2019. 

Kathleen Mooney, PhD, Professor of Nursing at U of U and Research Director of Huntsman at Home, led the study. She recently told State of Reform that Huntsman has been focused on addressing issues of access and equity in rural areas. 

“When [rural cancer patients] get into trouble, they don’t have a specialist to take care of that acute episode, or people in their community that can help them to prevent those episodes,” Mooney said. “We know that it’s more difficult for rural-dwelling people to access cancer specialty care, and so there is an access issue there that we’re trying to bridge.

There’s also an equity issue … we don’t just want to build out programs that work in Salt Lake. We want to see how we can adapt them and put them into communities at a distance. We have a demonstration project trying to evaluate [rural access and equity] that is in process right now.”

HH has expanded from the Salt Lake Valley to 3 rural counties in Southeast Utah where access to specialty care is nonexistent and travel to the nearest Huntsman clinic poses a challenge for many patients due to distance. 

While the Huntsman Cancer Institute has a plan to scale the program to other areas of the state, Mooney said the program’s lack of a reimbursement model restricts expansion. 

“Cancer care, as well as a lot of other chronic disease care, does not have a home-based delivery model,” Mooney said. “The model of care is hospitalization as needed, and clinic visits to manage the condition. There isn’t home-based care, certainly not acute care that is substituting for a hospitalization or home-based care that substitutes for an emergency department evaluation. 

The challenge for a hospital at home model is how to be reimbursed because reimbursement for home health visits is really episodic [and for] non-urgent care, and is not something that is sustainable. It…