Having a bone marrow transplant used to mean being shut up for months in a hospital room, in some cases in isolation. Now, under a new model introduced at Johns Hopkins Hospital in May, transplant patients who qualify are spending half of their visit as outpatients in a "medical hotel" - - complete with a microwave oven and other amenities.
The model, called IPOP, for Inpatient/Outpatient Care Continuum, was developed by a team of Hopkins nurses and oncologists. It is expected to save patients $10,000 each and help Hopkins attract more transplant patients in an increasingly competitive marketplace.
The average cost of a bone marrow transplant ranges from $80,000 to $150,000, depending on the severity of a patient's cancer or other disease, the complexity of the transplant, and the overhead of the hospital performing the procedure. But by last year, Hopkins' costs had swung over the high end of that spectrum, to $160,000 per patient.
Under the protocol Hopkins had been using, transplant patients spent, on average, 47 days as inpatients. Under IPOP, the basic bone marrow transplant procedure stays the same. What's different is that a patient spends just 20 days in an inpatient ward. The patient and a caregiver (a friend or family member) then move into one of two "medical hotels" - - either the Joanne Rockwell House or the Hackerman-Patz house, both located across the street from Johns Hopkins Hospital. "They're more like an apartment than a hotel," says Georgia Vogelsang, clinical director of bone marrow transplant. If patients develop complications, they can be moved back to the hospital immediately.
A few years ago, a model like IPOP would have been unheard of, says Vogelsang. It's possible now, she says, because doctors have dramatically improved their ability to care for patients lacking immune systems through such techniques as prophylactic doses of antibiotics, which protect against infections.
In addition to saving patients money, the model also improves the quality of care, says Jane Shivnan, a fellow in planning and marketing at the School of Nursing, who helped develop IPOP. For one thing, it streamlines care by allowing transplant patients to see a single team of specialists throughout their visit. Before, patients saw one team as inpatients and a different team as outpatients, which sometimes led to confusion and miscommunication, she says.
For Hopkins, freeing up inpatient beds makes it possible to perform more bone marrow transplants and increase revenues. Vogelsang anticipates that her team will conduct an additional 60 bone marrow transplants throughout the next year, over the current 127 they have been doing.
Hopkins is currently offering the new model to adult patients with hematologic malignancies (leukemia, lymphoma, and related cancers), but plans eventually to treat other categories of bone marrow transplant patients this way.
Melissa Hendricks is the magazine's senior science writer.
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