Hospital-at-home programs, designed to deliver acute-level care in the comfort of a patient’s residence while reducing costs, gained significant momentum even before the pandemic. The unprecedented surge in virtual care and remote monitoring tools during COVID-19 further amplified interest in these models.
However, the widespread adoption of hospital-at-home programs faces significant obstacles. Physician hesitancy and inconsistent reimbursement policies are major roadblocks. Furthermore, a crucial government waiver that facilitated the expansion of at-home hospital care during the pandemic is set to expire with the end of the public health emergency. This looming expiration has sparked concerns among advocates who fear a reversal of the progress achieved during the COVID-19 crisis.
“Most healthcare organizations identify moving care to the home as a key strategic priority,” stated Chris McCann, CEO of Current Health, a technology platform specializing in at-home care, in an interview with Healthcare Dive at the HIMSS annual conference. “Yet, far fewer have actually implemented it.”
Physician Reluctance: A Major Hurdle
Despite growing investment and interest from major healthcare systems like Kaiser Permanente and Mayo Clinic, hospital-at-home programs are experiencing slow uptake. A significant barrier is the reluctance of both patients and healthcare providers to fully embrace these models. Experts at HIMSS emphasized that change management is a critical challenge hindering broader adoption.
Hospital staff, in particular, harbor concerns about their ability to provide the same quality of care in a patient’s home as they do in a hospital setting. This skepticism leads to hesitancy in referring patients to hospital-at-home programs, even when physicians and nurses conceptually support the idea. Adding to this, some providers express apprehension about increased legal risks and potential malpractice claims arising from adverse clinical events occurring in a patient’s home.
An illustrative example comes from HCA Healthcare, a large hospital operator, which ran an at-home care program for COVID-19 patients. They encountered resistance from providers who were unwilling to discharge patients to home-based care.
“Our providers didn’t feel comfortable sending them home,” noted Sherri Hess, chief nursing informatics officer at HCA Healthcare. Hess pointed out the higher costs associated with keeping patients hospitalized, even when their vital signs could be effectively monitored at home. “Was keeping them in the hospital truly the optimal approach?” she questioned.
Nathan Starr, lead telehospitalist for Intermountain Health, highlights the difficulty clinicians face in adapting to treating patients outside the controlled environment of a hospital.
According to Starr, this “loss of control” is “one of the hardest things for clinicians” to overcome. “Frankly, we’ve encountered physicians who have genuinely struggled with this transition.”
Overcoming this physician reluctance is not a quick fix. Hospital staff need to gain confidence in using telemedicine resources and develop trust in the patient and their family’s ability to accurately report symptoms and adhere to the care plan, Starr advises.
Debunking Cost Concerns
With the rapid rise of telehealth in early 2020, some industry observers worried that virtual care might inflate healthcare costs by adding virtual visits without replacing traditional in-office appointments. Similar concerns have been voiced about hospital-at-home programs, despite mounting evidence indicating that well-managed at-home treatment can be more cost-effective and equally or even more effective than conventional hospital care.
Studies suggest that this model can achieve savings of 30% or more per admission, while also reducing complication rates compared to in-hospital care, as demonstrated by a Commonwealth Fund pilot program.
“I’ve heard arguments about how hospital at home could increase costs. I don’t believe them because the data and our experiences with hospitals on the ground simply don’t support that,” McCann asserted.
Current Health, recently acquired by Best Buy as part of the retailer’s expansion into in-home care, has a strong presence in the United Kingdom, a country more advanced in hospital-at-home adoption than the U.S. McCann reported that Current Health’s UK operations have saved 6,500 bed days across 1,000 patients, with a remarkable 99% patient satisfaction rate.
“Our ultimate goal for hospital at home is to completely replace the inpatient stay,” and manage the entire episode of care at home, explained Starr from Intermountain, a pioneer in adopting at-home care models. “Otherwise, we risk simply adding to medical expenses.”
The Appeal of Home Comfort
Patient feedback on hospital-at-home programs is overwhelmingly positive, speakers at HIMSS noted.
“Patients love it. This is a near-universal finding. They prefer to be at home,” Starr emphasized.
Research indicates that for many individuals, unfamiliar surroundings amplify stress, while their own home environment promotes comfort and well-being. Sriram Bharadwaj, VP of digital innovation at Franciscan Alliance, a regional Catholic health system, pointed out that this comfort factor contributes positively to the healing process.
Hospital-at-home programs hold particular promise for underserved populations, including low-income and rural communities. McCann noted that populations facing access barriers often demonstrate greater engagement with healthcare services delivered at home compared to traditional hospital settings.
Historically, slow payer acceptance has hindered hospital-at-home models. However, many health insurers are now embracing these programs. Humana, for example, is offering its own at-home models, attracted by the potential for cost reduction without compromising care quality.
“It’s not just Humana; all payers are entering this market and expanding their presence,” observed Tina Burbine, VP of care innovation at Healthlink Advisors.
The Uncertain Future of the CMS Waiver
Prior to the pandemic, CMS, along with most private payers, did not reimburse for hospital-level care provided at home. This reimbursement gap severely limited access and restricted implementation to a small number of providers. However, during the COVID-19 public health emergency, the government introduced a waiver allowing hospitals to provide home care to patients who would otherwise require inpatient hospitalization.
This temporary flexibility opened significant opportunities for providers. Within the first year, 190 hospitals signed up for the waiver.
The waiver’s impending expiration, tied to the end of the COVID-19 public health emergency (currently expected in April, with a potential 90-day extension), casts a shadow over the future of these programs. A bill in the Senate proposes extending the waiver for another two years.
McCann warned that the waiver’s expiration would be “very damaging to the progress we’ve made.”
However, alternative reimbursement pathways exist. Intermountain, for instance, chose not to utilize the waiver, integrating its hospital-at-home program into its value-based care model for at-risk patients, Starr explained.
While Starr advocates for making the waiver permanent, he also acknowledges the equity challenges in nationwide hospital-at-home implementation. Delivering acute-level care is relatively straightforward in affluent urban areas with short distances between patients and hospitals, and where hospitals have access to the often-expensive medical devices needed for remote patient monitoring.
“What about smaller community hospitals covering entire counties? How do we provide programs for patients spread across vast geographic areas with wider socioeconomic disparities? A single model struggles to fit all these diverse situations,” Starr pointed out.
Other IT experts concur that while hospital-at-home shows great promise, it’s not yet ready for widespread adoption across the U.S. Many populations who could benefit most lack the necessary broadband access to support monitoring devices and virtual check-ins with their care teams.
Aashima Gupta, director of Global Healthcare at Google Cloud, speaking at a panel on tech-enabled aging, emphasized that “seamless connectivity is needed between virtual and home” before broader adoption can occur.
Proponents also express concern that as COVID-19 cases decline, hospitals might redirect resources away from these programs, favoring more financially lucrative inpatient care. However, a recent Moody’s report suggests that the shift away from acute settings towards outpatient, community, and home-based care is expected to continue gaining momentum.
“The pandemic initially overshadowed financial models… but now, as COVID has receded, financial considerations are resurfacing,” McCann from Current Health observed. “This financial aspect likely remains the primary factor holding back broader progress in this space.”
