As hospital at home shows promise, its obstacles sound familiar to rural providers

A recent study reinforced that the hospital at home model may improve short-term clinical outcomes but raised longstanding concerns about equitable access to HaH programs, especially in rural areas. 

The JAMA Network Open paper found lower in-hospital mortality and ED use within 30 days of discharge compared to traditional inpatient admissions. Among nearly 16,000 fee-for-service Medicare beneficiaries, the HaH mortality rate was 0.4%, compared to 3.6% for inpatient stays. Meanwhile, ED admission rates for those at home were 8.8% over 30 days compared to 10% for this receiving inpatient care. (There was no significant difference in readmissions for either site of care.) 

The American Journal of Managed Care said the findings provide further support for home-based alternatives to traditional hospitalization. That’s especially true amid growing inpatient demand, limited capacity, workforce shortages, strained finances, and advances in remote monitoring technology.  

Both providers and professional organizations support the HaH model, given its demonstrated impact on clinical outcomes and potential cost savings of up to 50%. It helps that hospital at home provides an up-close view of social drivers of health that can’t be obtained from in-person appointments, survey responses, or data downloads. Patients have embraced hospital at home as well, with more than 80% of previous program participants reporting a positive experience.  

To that end, in February Congress authorized a five-year extension of the Acute Hospital Care at Home program, which provides Medicare funding to participating hospitals. The program began during the COVID public health emergency so hospitals could provide inpatient-level care while reducing the risk of exposure to patients being treated for COVID. The extension followed struggles for hospital at home during the 2025 government shutdown, as many providers scaled programs back when funding wasn’t available. 

Access, infrastructure, and orchestration challenges remain

However, hospital at home still faces hurdles. Access is a big one. The JAMA paper examined data from 68 hospitals over a two-year period. Eleven accounted for half of all HaH admissions; all were in urban areas and affiliated with larger heath systems, and 10 of the 11 were in the Northeast or South.  

The findings “underscore the need to address practical and implementation challenges to broaden equitable access and obtain consistent clinical benefits across health systems,” the study’s authors concluded. 

Added AJMC: “[B]roader adoption will require sustained investment in workforce capacity, standardized implementation frameworks, and policy mechanisms that ensure equitable access across urban and rural settings.” 

That may be a matter of orchestration and not necessarily technology. Remote monitoring devices and durable medical equipment are advanced enough. The challenge is properly integrating them with care pathways, clinical workflows, and electronic health record systems without further exhausting care teams – or IT support staffers that traditionally haven’t directly engaged with patients. 

HaH adoption obstacles also parallel the roadblocks for rural health transformation. Here, experts have indicated a combination of shared infrastructure and collaborative governance may be necessary to ensure organizations not only execute next-generation care delivery but also demonstrate clinical and financial value. 

In rural health, CMS is looking for programs that will ultimately sustain themselves. Evidence suggests the HaH model could fit the bill – and since its challenges mirror the main system-level impediments many rural hospitals face, supporting HaH may provide a foundation for long-term transformation.  

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.