Does hospital at home have a light at the end of the tunnel?

Though both telehealth and hospital-at-home programs have received temporary extensions of benefits yet again, neither market segment is exactly confident about its future. Telehealth is struggling to achieve sustainability due to flattening utilization rates, disinterest from payers, and a fear of forthcoming administrative burdens. For the hospital at home, the path is no less uncertain, though a reprieve may be on the way. 

First, some good news. Last month, NewYork-Presbyterian launched Hospital at Home, making remote monitoring, virtual visits, pharmacy support, and complementary in-person care available to eligible patients after discharge. NYP joins a growing list of facilities offering acute care at home – nearly 420 hospitals in 39 states as of September, according to the Centers for Medicare & Medicaid Services (CMS). 

The hospital at home has caught on largely because providers and patients prefer it. Programs improve clinical and financial outcomes, with lower mortality rates as well as cost savings between 30% and 50%. It helps that technology is familiar, use cases are strictly defined, and CMS criteria determine eligibility. Providers can use existing telehealth and remote monitoring tools, they know what conditions are being treated and what vital signs must be monitored, and they need not develop complex predictive models to decide who to enroll. 

Meanwhile, a 2024 survey found more than 80% of hospital at home participants report a positive experience. A similar percentage of patients who had yet to receive care at home said they would if it meant they could leave the hospital sooner. Not surprisingly, patients like the comfort and convenience of home and are quite happy to avoid hospital-acquired infections. 

Despite mounting evidence of success and preference, Congress has repeatedly punted on permanent financial support for hospital at home support. As with telehealth flexibilities, approvals have come in the form of temporary waivers, often enacted within weeks or days of their expiration.  

When waivers have expired, as they did during this fall’s government shutdown, the ripple effect has been palpable. According to Politico, some hospitals anticipated the shutdown and scaled back services prior to Oct. 1, the first day of the shutdown. Others had no choice but to put hospital at home on pause; they almost immediately saw increased demand – and longer wait times – for inpatient beds. The timing was especially ominous, as mid-October marks the beginning of infectious respiratory disease season. 

Vendors felt the pain, too. In early December, hospital-at-home platform Inbound Health shut down abruptly. The Allina Health spinout had raised $50 million in venture capital and was announcing new customers as recently as this summer, though the company’s CEO told Politico staff furloughs were likely since federal funding to its health system customers dried up during the shutdown.  

To help prevent these scenarios in the future, providers and professional organizations have called for at least a five-year waiver to cover hospital at home reimbursement. This would allow providers to get programs set and avoid disrupting access to care. A U.S. House bill passed Dec. 1 would extend the current temporary waiver until Spt. 30, 2030, reported Healthcare Dive. The bill is now in the Senate’s hands. 

An extension, according to the American Hospital Association, “will not only provide additional time to continue gathering data on quality improvement, cost savings, and patient experience, but will also provide much-needed stability for new programs and may ease state concerns about updating Medicaid policies to cover these services.” 

Brian Eastwood is a Boston-based writer with more than 10 years of experience covering healthcare IT and healthcare delivery. He also writes about enterprise IT, consumer technology, and corporate leadership.