Welcome Home: The Expansion of At-Home Hospital Care

The Mayo Clinic was among the first hospitals in the country to experiment with sending acute patients home for remote care four years ago. Now, approximately 250 similar programs exist throughout the country.

That’s largely because during the pandemic, the Centers for Medicare & Medicaid Services (CMS) relaxed normal rules requiring around-the-clock, on-site nurses for hospitals requesting the exception. This allowed at-home hospital care programs to rapidly expand. Those pandemic-era waivers will remain in place until at least the end of 2024, although some experts anticipate policy changes allowing such programs to remain in place permanently.

Most hospital-at home programs provide in-person medical visits twice or three times a day with nurses or paramedics taking patients’ vitals, replenish medications and supplies, and consulting with a doctor via video conference, if necessary.

Going to your home to receive acute care sounds— on its face— fantastic, as people feel more comfortable in their own home. However, everyone worries about complications. The hospital-at-home is a voluntary program.

Johns Hopkins created narrowly defined eligibility criteria to help distinguish patients who need intensive services and multiple visits from specialists—and therefore should be treated in hospital settings—from those whose needs may be met at home by visiting physicians, nurses, and other clinical staff.

Conditions with defined treatment protocols, such as congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), community-acquired pneumonia, and cellulitis, are a natural fit.

Early trials of its model (conducted by Johns Hopkins) found the total cost of at-home care was 32 percent less than traditional hospital care ($5,081 vs. $7,480), the mean length of stay for patients was shorter by one-third (3.2 days vs. 4.9 days), and the incidence of delirium (among other complications) was dramatically lower (9% vs. 24%).

One study of the program also found no difference in rates of subsequent use of medical services or readmissions. And patients and family members’ satisfaction was higher in the home setting than among those offered usual hospital care, reflecting the convenience of the model.

The current waivers will remain in place until 2024. But COVID really did advance remote health with telemedicine and hospital care at home. Many believe that hospital at home is here to stay. The model is common in other countries.

Lastly, CMS published the 2024 Medicare Physician Fee Schedule, which includes a $1.14 (3.34 percent) conversion factor decrease from 2023.

Only 75 percent of physicians accept Medicaid. The percentage decreases when you talk about specialists or dentists. More physicians accept Medicare, but with these decreases in Medicare reimbursement, who knows if the percentage will decrease more.