O2061: Growing @ Home: A cost saving opportunity for early discharge from the neonatal intensive care unit

Background: Preterm infants have birth hospitalizations associated with high direct medical costs and out-of-pocket costs for the family. In May 2019, our neonatal intensive care unit (NICU) started a remote patient monitoring program, Growing @ Home (G@H), to facilitate discharge of infants with inadequate oral feeding on home nasogastric tube feeds under the direct supervision of a neonatologist. We describe costs associated with discharge on G@H compared to the counterfactual continued NICU hospitalization.

Methods: The study was conducted in a metropolitan, level IV NICU. Patients discharged on G@H from May 2019 – March 2024 are included. G@H eligibility criteria include: (1) >/=35 weeks corrected gestational age, (2) weight >/=2 kg, (3) ability to take at least 30% of feeds orally, (4) toleration of full enteral feeds, (5) > 5 days of cardiorespiratory stability, and (6) mature thermoregulation. Infants were included if they graduated G@H with full data collection and achieved full oral feeds within 60 days of NICU discharge. The analysis is performed from a payer perspective due to lack of availability of parent out-of-pocket expenses. Number of days with home nasogastric tube feeds, number of days on G@H, and total physician time spent per G@H episode were recorded; means with standard deviations (SD) and medians with interquartile ranges (IQR) were calculated for each parameter. Prices for specific Current Procedural Terminology codes were taken from the 2024B Centers for Medicare & Medicaid Services physician fee schedule for national payment amounts. The difference between the estimated cost of continued hospitalization and the estimated cost of discharge on G@H was calculated to determine the direct medical cost savings for discharge on G@H. All costs are represented in 2024 US dollars. Initial contracting fees with the remote patient monitoring company and physician salary support are not included in this analysis.

Results: Of 211 infants discharged on G@H, 168 were eligible for analysis. Table 1 describes characteristics of the cohort, including the means (SD) and medians (IQR) for days of home nasogastric tube feeds, estimated hospital days saved (days of tube feeds plus two; standard practice in our NICU), days on G@H, and physician time spent per G@H episode. Table 2 describes the breakdown of costs for continued hospitalization and discharge on G@H, using mean and median data for hospital days saved and total physician time spent per G@H episode, as well as direct cost savings per patient and for the cohort utilizing discharge on G@H.

Conclusion: In the five years since establishing G@H, our program has contributed a minimum savings of $1.24 million of direct medical costs for the 168 patients who have discharged to home and achieved full oral feeds within 60 days.