Although Dr. Bruce Leff [Hospital Care in the Home on the Horizon, ACEP News, March 2011] and his colleagues found that duplicating a hospital environment at home is possible for a wide array of illnesses, especially those of a chronic nature, others are not convinced that this model can provide clear cost savings, primarily due to the fact that many trials had too few patients to determine whether the perceived “savings” are real or statistically significant.

Since American society is currently at odds about how to pay for anyone’s health care, the belief in affordable, comprehensive, high-tech home care is naive at best. The motion detector experiments of Dr. Cook and her colleagues at Washington State University, Seattle, are lagging in terms of reality, as a monitoring system has been used for more than

10 years in a for-profit assisted living facility named Oatfield Estates in Milwaukie, Ore. Residents pay $3,600-6,000 per month, not including the cost of medication or medical care. Dr. Cook’s view about a Home Depot purchase of a simple monitor ignores the fact that someone with training has to look at what the monitor transmits, interpret the data, and make decisions. Those services will not be free.

But house calls do work. This simple act – combined with a system that has a team approach to care (the essence of the medical home concept) and electronic health records – can duplicate in-hospital care results for the most common conditions usually treated during a hospital stay: pneumonia, COPD, cellulitis, and heart failure (currently the most costly chronic health problem in this country). Having worked in a hospital environment for most of my career in emergency medicine, I know where I would want to be treated if I had a choice between hospital and home.

Stephen C. Acosta, M.D.
Portland, Ore.

Dr. Acosta is affiliated with the Program at Home, Department of Rehabilitation and Long-Term Care, Portland VA Medical Center.