The trouble with Hospitals in the Home

Patients admitted under HITH programs are still technically inpatients, meaning they cannot access MBS rebates for GP consultations through that time. Something has to give.

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The RACGP is begging for hospitals to give GPs “a break” when it comes to Hospital in the Home programs, some of which prevent patients from accessing Medicare rebates while still technically admitted.  

Popularised over the acute phase of the pandemic, HITH services are designed to deliver acute, hospital-level clinical services to patients in their home or aged care home.  

Conditions treated under the model range from community acquired infections like pneumonia through to chemotherapy and complex wound care.   

Its popularity comes not only from the fact that it is convenient for the patient, but because it is also significantly cheaper for the hospital. 

“Hospitals are not actually having to provide all of those expensive services that go along with the provision of a bed. They’re just having to provide the medical service intervention,” Associate Professor Charlotte Hespe told The Medical Republic. 

Professor Hespe, a GP in inner Sydney, was chair of the RACGP NSW faculty throughout covid and campaigned for consistent rules for HITH services across hospitals during that time.  

Where things can get frustrating, Professor Hespe said, is when patients admitted under HITH try to access their regular GP for an unrelated issue and find they aren’t eligible for Medicare rebates because of their inpatient status. 

“When they’re in the hospital, they’d just seek out the intern or the resident and get it sorted out, or they’d get one of the other teams to come in and sort it out,” she said.  

In a letter to Health Minister Mark Butler this week, RACGP president Dr Nicole Higgins requested the removal of restrictions on HITH patients claiming MBS items to make the process more “straightforward”.  

“All of these hospitals espouse their values of delivering patient-centred care and they will say that they’re doing a hospital in the home service because it’s better for the patient,” Professor Hespe said.  

“If it’s truly better for the patient, then we need to align the model of funding to enable them to access their GP if they’re being looked after in the community.” 

Associate Professor Michael Montalto, a GP who heads the HITH unit at Epworth Richmond, told TMR that he felt it should be the other way around; hospitals should step up care delivery, not hand it over to GPs. 

“It’s important to keep to the definition of HITH as a hospital service regardless of the obvious fact that the patient is at home,” he said.  

“This is a major evolution in the way hospitals should think about and deliver care in the future.  

“But the complexity, severity of the patient’s condition or the technical and hospital-based nature of the treatment means that it remains in the hospital domain.” 

He also argues that the ad hoc involvement of a GP while patients are technically admitted muddies the clinical responsibility waters.  

“If the GP changes treatment, it may impact the underlying condition being treated in HITH,” Professor Montalto said.  

“The GP might not even be completely aware of the problem being treated in HITH.  

“It’s the main reason GPs don’t attend patients in hospital in our cities and change treatment on the wards: it fragments the care and the responsibility for that care.”  

There’s also the basic fact that an admitted patient is the hospital’s responsibility, and one that it should not be able to shirk.  

“Hospitals are paid equivalent inpatient rates to provide acute care to HITH patient, so they should pay for all the medical care to their HITH patients, just as they would for any inpatient,” he said. 

Professor Montalto’s views do not represent those of his employer.