07/18/2025 | News release | Distributed by Public on 07/18/2025 08:28
Hospital-at-home programs - in which patients receive acute-level care in their homes instead of a hospital setting - have grown in popularity since the peak of the COVID-19 pandemic. In this health care model, some patients who normally would receive care in the hospital, such as for an infection, an exacerbation of a chronic illness, or after surgery, for example, are given the option to receive extra care while recuperating in their homes.
Hospitals and health systems offer different models of these programs. Most provide technical equipment such as wireless blood pressure cuffs and pulse oximeters, and send nurses or other allied health professionals to the patient's home for visits, or have some type of secure mobile application through which patients can share their vital signs, contact their care team and participate in video visits to monitor their progress.
Physicians from Los Angeles General Medical Center, The Permanente Medical Group, and Mayo Clinic Arizona discussed their versions of hospital at home programs during Health Journalism 2025. This tip sheet offers more information and context to help frame your reporting and provide you with ideas for stories.
What is the history of these programs?
Programs like this were popping up in Europe, Australia and Canada as far back as the 1970s, but their start in the U.S. in the mid-1990s is attributed to Bruce Leff, M.D., a geriatrician at the Johns Hopkins University School of Medicine in Baltimore, according to the Global Journal of Quality and Safety in Healthcare. In his initial program, patients ages 65 and older with conditions such as community-acquired pneumonia, cellulitis, heart failure exacerbation or chronic obstructive pulmonary disease that required hospitalization were selected to receive acute care at home, according to a story in Cardiovascular Business.
Leff piloted the concept in a small group of patients at Johns Hopkins and expanded it to patients in the Department of Veterans Affairs, Time magazine reported. When the COVID-19 pandemic began in 2020, the federal Centers for Medicare and Medicaid Services (CMS) launched a waiver-based program allowing several hundred hospitals to be reimbursed for providing acute care at home, with the idea of freeing up hospital beds for critically ill patients and protecting patients from exposure to the virus. This greatly expanded the programs. The waiver has since been expanded several times and now is in place until Sept. 30, 2025.
As of November of last year, 378 hospitals across 140 health systems and 39 states had been approved to provide hospital-at-home services, according to an April 2025 fact sheet from the American Hospital Association. Other health systems and hospitals have indicated they are interested in starting programs but are hesitant to do so without a long-term extension in place from Congress. Some programs operated by hospitals offer these services to additional patient populations including those who have commercial insurance.
Some health systems are using these practices - remote monitoring of patient vital signs and online or phone visits - as part of prevention plans to keep patients out of the hospital. Ochsner Health in New Orleans has had a digital medicine program since 2015 to manage patients with hypertension, diabetes and high cholesterol, which I wrote about for Medscape. More than 90% of participants have brought their hypertension and diabetes into healthy ranges through participation.
What about outcomes?
CMS released a report in September 2024 demonstrating that hospital-at-home is safe and effective. Specifically, the agency found that participating patients had lower mortality rates, lower hospital readmission rates and lower spending in the 30 days after hospital discharge. While the report did find that patients tended to be white, live in urban locations, and less likely to receive Medicaid or low-income subsidies, this can in part be attributed to the variability in state Medicaid coverage of the program, according to this AHA fact sheet. As of June 2024, only 12 states provided Medicaid coverage for hospital-at-home.
Mayo Clinic Arizona has saved almost 3,900 bed days through the program. Only 11% were readmitted to the hospital, compared with 17% who spent time in the hospital and then went home. A Mayo Clinic randomized controlled trial comparing advanced care at home versus hospitalization found that safety was equivalent between those in the hospital versus the at-home program, while the hospital-at-home option was associated with a higher likelihood of patients reporting feeling extremely comfortable.
Los Angeles General Medical Center has a virtual hospital-at-home model that does not provide any in-home visits, but if a patient looks unwell during a video visit, the medical center will dispatch an Uber driver to pick them up and bring them to the hospital for in-person evaluation. A recent study found the program saved the hospital $5.6 million, the result of not having to admit patients to the hospital who had Medicaid or were uninsured. Patients who participated in the program spent four days fewer on average than those in the physical hospital.
Are these programs expanding?
There have been several news stories lately about health systems expanding hospital-at-home programs to additional patient populations or trying new services. Here are some examples:
Atrium Health Levine Children's Hospital in Charlotte, N.C., developed a pediatric hospital-at-home program, building on its adult program. The program is staffed by board-certified pediatric hospitalists, nurses, child life specialists and paramedicine technicians. Services include IV medications and fluids, breathing treatments, and wound and postsurgical care.
UMass Memorial Medical Center in Worcester is testing the concept of skilled nursing facility at home, or subacute at home, in which services typically provided at a skilled nursing facility are instead offered at home, with visits from caregivers and remote monitoring technology, according to this recent story by AHCJ Board President Felice Freyer. The concept is also being used at facilities in New York, Pennsylvania and Wisconsin.
UMass Memorial Health offers a postpartum home hospital program for patients who have had cesarean births. After delivering their baby, eligible patients leave the hospital when they feel ready. Nurses visit patients at home several times a day, and patients meet with their doctor virtually at least once a day. Vital signs such as blood pressure, heart rate and body temperature are monitored around the clock.
One of the largest programs, operated by Mass General Brigham, is testing drone delivery of hospital-at-home supplies, which would allow the hospital to facilitate care for patients who live in communities farther from the hospital campus.
How do patients feel about the programs?
News stories including this one from Becker's Health IT indicate that patients are happy being able to recover in familiar surroundings, with family members and pets close by. Patients have loved the care model, Richard Rothman, M.D., chief medical operations officer of Cleveland Clinic Florida, told Becker's Health IT : "Patient experience scores are amongst the highest patient experience scores we've seen in any of our inpatient wards across the Cleveland Clinic."
The health system launched acute hospital care at home in April 2023. A 24-7 virtual command center in Vero Beach, Fla., is staffed by hospitalists, nurses and pharmacists who manage patients remotely, and the health system contracts with community health care providers to supply in-home nurses, paramedics and other clinicians.
What do critics say?
Not everyone is on board. The American Association of Retired Persons (AARP), a nonprofit organization that advocates for older adults, has raised concerns about the burden on family member caregivers, a recent article in Knowable magazine said. The article also notes that the government has not yet developed regulations for home hospitals that equal brick and mortar hospitals.
National Nurses United, the country's largest union of registered nurses, also has criticized the programs, referring to them as "home all alone," according to Time magazine.
A December 2024 study in the Journal of the American Medical Association pointed out that the majority of hospitals offering such programs were large, urban, nonprofit and academic hospitals. If CMS wants to expand the reach of hospital-at-home, more work must be done to incorporate smaller, rural and non-teaching hospitals, according to a news release from UCLA, where two of the report authors work.
"These types of hospitals are not seeking to create these programs on their own, potentially because of the resources involved in creating and sustaining their operation until they scale," the news release said.
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