Hospital at home models gain the followers that matter: the patients

At the height of the pandemic, when hospitals were overrun with infectious disease patients and open beds were at a premium, CMS’s decision to expand its hospital at home program was popular with beleaguered administrators and burned out providers.  

At-home remote patient monitoring allowed providers to keep tabs on serious but stable patients who didn’t quite need to be occupying places that had to be reserved for COVID cases, expanding capacity at the most critical time. Clinicians liked that it reduced burdens while producing acceptable outcomes, while C-suites were thrilled to see the potential for reducing spending, with one health system citing reductions of up to 30% of the costs of traditional inpatient care. 

After rapidly expanding from just six hospital systems to more than 320 across the nation, it’s become clear that the initiative isn’t just a win for health systems themselves. It’s also becoming very popular with the patients who participate in the program. 

A new survey from Vivalink, which provides remote monitoring solutions, found that more than 80% of more than 1000 patients who partook in a hospital at home program had a positive experience during their treatment and recovery.  

A similar number (84%) would choose to receive care at home if it meant getting out of the hospital sooner. 

Patients cited multiple benefits of home-based remote monitoring, including the convenience and comfort of being at home (46%) and the reduced likelihood of being exposed to infectious diseases in the hospital setting (23%). And while just 18% said their trust in remote monitoring tools was a primary reason to participate, growing familiarity with digital tools is no doubt a factor in choosing home-based care. 

The majority of patients participating in the survey experienced heart conditions (45%), cancer (37%), neurological conditions (37%), and diabetes (34%), while smaller numbers received care for infectious diseases and respiratory disorders.  

While these results are encouraging for an industry that has started to prioritize consumerism above many other considerations, health systems still have plenty of reasons to hold off on launching their own initiatives, at least for now. 

For one thing, the pandemic-era CMS version of the program, known as Acute Care Hospital at Home, is set to expire at the end of 2024 without Congressional intervention. There’s a bipartisan effort underway to save it for at least another five years, with support from the first pioneering health systems and advocacy groups including the American Hospital Association. 

Opponents cite the lack of long-term clinical evidence for better outcomes, considering that researchers have tended to use Medicare’s 30-day readmission metric as an early benchmark for success, the technical challenges of data exchange and interoperability, and the risks that the lack of strong oversight could lead to variations in clinical quality and the potential for financial abuse of taxpayer funds. 

However, extending the experiment by a defined length of time could generate the evidence needed to better understand the broader implications of shifting more care into the home – a trend that is already happening and is likely to continue no matter what happens with this specific program. 

With up to $265 billion likely to flow in that direction by 2025, according to an estimate from McKinsey, it might make sense to keep as much structure around the process as possible for more serious clinical cases while it’s still more or less under the government’s control. 

While the future of Medicare’s program may hang in the balance, it seems likely that patients will continue to demand innovative options that blend clinical excellence with consumer-centered convenience. The technology to drive these new models is evolving quickly – it will be up to policymakers and regulators to make sure they can put the right administrative and financial guardrails in place to harness the momentum and appropriately manage the evolution of care from the inpatient setting to the patient’s living room. 

Jennifer Bresnick is a journalist and freelance content creator with a decade of experience in the health IT industry.  Her work has focused on leveraging innovative technology tools to create value, improve health equity, and achieve the promises of the learning health system.  She can be reached at jennifer@inklesscreative.com.