Hospital-at-home programs were gaining momentum even before the pandemic, promising to reduce costs while delivering acute-level care within the comfort of patients’ homes. The COVID-19 crisis further accelerated the adoption of virtual care and remote monitoring technologies, highlighting the potential of these innovative healthcare models.
However, despite the buzz and demonstrated benefits, the widespread implementation of hospital-at-home programs faces significant headwinds. Physician hesitancy and inconsistent reimbursement policies are major roadblocks. The expiration of a crucial government waiver, which temporarily broadened access to at-home hospital care during the public health emergency, raises concerns about losing the progress achieved during the pandemic.
“Most healthcare organizations state that moving care to the home is a strategic priority,” Chris McCann, CEO of Current Health, a care-at-home technology platform, noted at the HIMSS annual conference. “Yet, fewer have actually taken substantial action.”
Physician Reluctance: A Core Barrier
While hospital-at-home models have attracted investment and interest from prominent healthcare systems like Kaiser Permanente and Mayo Clinic, broader acceptance is slow. A key challenge lies in overcoming the reluctance of both patients and healthcare providers to fully embrace this care model. Change management within hospitals is a significant obstacle to wider adoption, experts emphasized at HIMSS.
Hospital staff, in particular, harbor concerns about whether the quality of care delivered at home can match that of a traditional hospital setting. This skepticism makes them hesitant to refer patients to hospital-at-home programs, even when they conceptually support the idea. Furthermore, some providers worry about increased legal risks and potential malpractice claims arising from adverse events occurring in a patient’s home environment.
For instance, HCA Healthcare, a major hospital operator, ran an at-home care program for COVID-19 patients but encountered resistance from providers to discharge patients to this setting. Sherri Hess, chief nursing informatics officer at HCA, explained that “Our providers didn’t feel comfortable sending them home,” even though home monitoring could effectively track vitals, potentially at a lower cost than inpatient care. This raises the question, “Was that really the right thing to do?”
Nathan Starr, lead telehospitalist for Intermountain Health, highlights the difficulty clinicians face in adapting to treating patients remotely. The “loss of control” inherent in home-based care is “one of the hardest things for clinicians.” Starr admits, “Frankly, we’ve had some physicians who have really struggled with that.”
Overcoming this physician reluctance requires building confidence in telemedicine resources and fostering trust in patients and their families to accurately report symptoms and adhere to care plans. There is no immediate solution, but gradual acclimation and demonstrated success are crucial.
Addressing Unfounded Cost Concerns
With the rapid rise of telehealth in early 2020, some industry observers expressed concerns that virtual care might inflate healthcare costs by adding virtual visits without replacing in-person encounters. Similar concerns have shadowed hospital-at-home programs, despite growing evidence indicating that well-managed at-home treatment can be more cost-effective and equally or even more effective than traditional hospital care.
Studies indicate that the hospital-at-home model can achieve savings of 30% or more per admission while potentially reducing complications compared to inpatient care. One pilot program highlighted that these programs improve outcomes and lower costs, although resistance persists.
Chris McCann from Current Health refutes the argument that hospital-at-home programs increase costs: “I’ve seen the arguments on how hospital at home could add cost. I don’t believe them and I don’t believe it because it’s not what we’re seeing in the data, and it’s not what we’re seeing in hospitals on the ground.”
Current Health, recently acquired by Best Buy to bolster the retailer’s home healthcare focus, has observed substantial success in the UK, a country more advanced in hospital-at-home adoption. Their UK operations have saved 6,500 bed days across 1,000 patients with a remarkable 99% patient satisfaction rate, according to McCann.
Intermountain Health, an early adopter of at-home care models, aims to fully replace inpatient stays with comprehensive at-home care episodes. Nathan Starr emphasizes that the goal is to avoid simply adding medical expenses but rather to substitute costly inpatient care with a more efficient home-based model.
The Undeniable Patient Preference: Comfort and Healing at Home
Patient feedback overwhelmingly favors hospital-at-home programs. “Patients love it. We’ve nearly universally seen that. They want to be at home,” Starr reiterated.
Research supports this, suggesting that the unfamiliar environment of a hospital can elevate stress levels, while the comfort of home promotes relaxation and healing. Sriram Bharadwaj, VP of digital innovation at Franciscan Alliance, points out that a familiar environment contributes positively to patient recovery.
Hospital-at-home programs also hold significant promise for enhancing healthcare access for underserved populations, including low-income and rural communities. These populations, often facing barriers to traditional hospital access, may find healthcare at home more accessible and engaging, McCann suggests.
Historically, payer acceptance was a bottleneck for hospital-at-home models. However, this is changing as many health insurers are increasingly embracing and even developing their own at-home programs, attracted by the potential for cost reduction without compromising care quality. Humana, for example, acquired Onehome to expand its value-based home health strategy.
Tina Burbine, VP of care innovation at Healthlink Advisors, notes that “it’s not just Humana who’s doing this. All of the payers are entering this market and are continuing to expand their presence here as well.”
Navigating the Waiver and Reimbursement Landscape
Prior to the pandemic, CMS and most private payers generally did not reimburse for hospital-level care delivered at home, severely limiting its adoption. The COVID-19 public health emergency prompted the government to introduce a waiver, allowing hospitals to provide home care for patients who would otherwise require inpatient admission.
This temporary flexibility unlocked significant opportunities for providers. In its first year, 190 hospitals enrolled in the waiver program.
However, the waiver’s impending expiration, tied to the end of the COVID-19 public health emergency, poses a threat. While an extension is anticipated, and legislative efforts are underway to extend it for two more years, the uncertainty surrounding long-term reimbursement remains a concern.
Chris McCann warns that the waiver’s expiration would be “very damaging to the progress we’ve made.”
Despite the waiver uncertainty, alternative reimbursement models exist. Intermountain, for instance, operates its hospital-at-home program within its value-based care arrangements, independent of the waiver.
While advocating for the waiver’s permanency, Starr acknowledges the equity challenges in nationwide hospital-at-home implementation. Providing acute care at home is more straightforward in affluent urban areas with shorter distances and readily available medical devices. However, serving smaller community hospitals covering vast, socioeconomically diverse regions presents logistical and resource allocation challenges. “How do we offer programs for patients with wide geographic spreads, with much wider socioeconomic spreads? That’s where one model is really hard to shoehorn into all these different situations,” Starr questions.
Infrastructure Limitations and Shifting Priorities
Beyond reimbursement and physician acceptance, infrastructure limitations hinder broader hospital-at-home adoption. Aashima Gupta, director of Global Healthcare at Google Cloud, emphasized the need for “seamless connectivity… between virtual and home,” highlighting the broadband access gap affecting many potentially benefiting populations. Without reliable internet, deploying monitoring devices and conducting virtual check-ins becomes impossible.
Furthermore, concerns arise about hospitals potentially deprioritizing hospital-at-home programs as COVID-19 recedes and traditional inpatient care volumes recover. However, a recent Moody’s report suggests that the shift towards outpatient, community, and home-based care is expected to continue gaining momentum, indicating a broader industry trend.
McCann from Current Health points out a recent shift in focus: “The thing is that Covid kind of evaporated the focus on financial model… we’re now seeing that pop back up, as Covid has trailed off. That’s probably still the area that most holds back the space.” The renewed emphasis on financial models and ROI could potentially slow down investment and expansion in hospital-at-home programs.
In conclusion, while hospital-at-home programs offer compelling benefits in terms of cost savings, patient satisfaction, and potentially improved outcomes, several challenges impede their widespread adoption. Overcoming physician reluctance, establishing clear and consistent reimbursement policies beyond temporary waivers, addressing infrastructure limitations like broadband access, and navigating shifting financial priorities are crucial steps to unlock the full potential of hospital-at-home care and transform the future of healthcare delivery.
