The future of healthcare might just lie in the comfort of your home, where acute-level hospital care is delivered right to your doorstep.

Story Snapshot

• Hospital-at-Home (HaH) model delivers acute care at home using remote monitoring and mobile care teams.
• Evidence suggests HaH reduces costs and complications while improving patient satisfaction.
• Challenges include safety, regulation, workforce management, and equity in remote care delivery.
• CMS’s Acute Hospital Care at Home (AHCAH) waiver is crucial to HaH’s rapid adoption during COVID-19.

Revolutionizing Patient Care at Home

Hospital-at-Home is transforming healthcare by bringing hospital-level care into patients’ homes. This model utilizes telemedicine, remote patient monitoring (RPM), and in-home clinical teams to manage complex patients who would traditionally require hospitalization. Originally developed by Johns Hopkins in 1995, early trials showed promising results, including lower costs and fewer complications than traditional hospital stays. Despite its benefits, HaH’s growth faced hurdles due to regulatory and payment barriers until the COVID-19 pandemic accelerated its adoption.

In November 2020, the Centers for Medicare & Medicaid Services (CMS) launched the Acute Hospital Care at Home (AHCAH) waiver to address hospital capacity issues during the pandemic. This waiver allowed hospitals to provide and bill for acute care services at home. Since then, hundreds of hospitals have adopted the HaH model, showcasing its potential to handle high-acuity patients safely and effectively outside hospital walls.

Operational and Ethical Challenges

The success of HaH hinges on the effective coordination of telemedicine workflows, command centers, and home visit logistics. These programs rely on a multidisciplinary team, including physicians, nurses, and paramedics, to deliver comprehensive care. However, safety concerns arise when technology fails or a patient’s condition rapidly deteriorates. The model also raises questions about equity, as patients without stable housing or reliable internet access may be excluded from this care option.

HaH programs must ensure robust escalation pathways and 24/7 on-call coverage to manage emergencies. Additionally, the reliance on caregivers for administering medications and monitoring symptoms increases their burden, posing a challenge to the model’s sustainability.

Watch:

Start your health journey in under a minute.

Policy Inflection and Future Prospects

The AHCAH waiver is set to expire in September 2025, creating uncertainty about the future of HaH models. Policymakers are debating whether to extend or make these waivers permanent. The decision will significantly impact hospitals’ investment in digital infrastructure and workforce planning. If made permanent, HaH could redefine hospitalization, shifting the focus from physical locations to levels of care delivered.

As technology and RPM devices become more integral to healthcare, questions about data privacy, cybersecurity, and vendor dependency will need addressing. The expansion of HaH also highlights the need for policy frameworks that ensure equitable access to this innovative care model.

Watch:

Got a health question? Ask our AI doctor instantly, it’s free.

Implications for Stakeholders

For hospitals, HaH offers a strategic growth area that can alleviate inpatient capacity constraints and reduce costs. It presents an opportunity to enhance patient experience by delivering care in familiar surroundings. Patients benefit from reduced hospital-acquired infections and increased autonomy, though caregivers may face increased responsibilities. CMS’s role is pivotal, as its regulatory decisions will shape the long-term viability of HaH models.

Technology vendors stand to gain from embedding their platforms into hospital operations, proving the safety and scalability of remote care. However, the model’s success hinges on addressing workforce challenges and ensuring that HaH does not exacerbate existing healthcare disparities.

Your new health companion is online, ready when you are.

Sources:

PMC Article
Health Recovery Solutions Blog
Nature Article
American Hospital Association
Center for Health Care Strategies
Commonwealth Fund
OHSU News
Current Health
Cleveland Clinic Podcast