Redefining Inpatient Care Through Hospital at Home

Authored by: Shriya Mehta

Art by: Leena Jalees

Getting hospital-level care no longer has to mean staying in a hospital. With remote monitoring, daily nurse visits, and virtual doctor check-ins, patients can now receive full treatment from the comfort of their home. The Hospital at Home (HaH) model, once a small experimental program, is now reshaping how Americans perceive inpatient care. The HaH program provides acute care for conditions like pneumonia or congestive heart failure through remote monitoring, telehealth, and in-person visits from nurses, doctors, and other medical staff [1]. The goal of this program is to cut costs, ease hospital crowding, and help patients recover in the comfort of their own homes. Still, as the model expands, many clinicians wonder if it can really replace a traditional hospital stay while keeping patients safe.

The HaH model provides hospital-level care to sick patients in their own homes. After a physician identifies an eligible patient, their home is evaluated to ensure it has basic utilities such as heat, water, internet access, and air conditioning [2]. A hospital-affiliated team then organizes transport, installs communication devices, and assigns a physician to oversee care [2]. At home, a nurse or caregiver checks in on the patient, and a physician reviews the treatment plan and writes orders. Once the patient stabilizes, care transitions back to their primary physician, with follow-up for up to 30 days to ensure continuity of care [1,2]. The follow up usually includes a review of the patient's health status, medication reconciliation, and a check of upcoming appointments.

Beyond its logistical design, evidence shows that HaH can achieve clinical outcomes comparable to or better than traditional hospital care. A landmark randomized controlled trial published in the Annals of Internal Medicine found that patients who received acute care at home had a 38% lower total direct cost and fewer 30-day readmissions than traditional hospital patients [1,3]. Patients receiving HaH were able to be more physically active, underwent fewer unnecessary tests, and reported higher satisfaction than those treated in traditional settings. Similarly, a 2021 JAMA Network Open analysis reported that HaH patients, mostly adults with chronic conditions and a median age of 71 years, experienced significantly lower readmission rates and comparable safety outcomes for respiratory and cardiac illnesses [4, 5]. This supports the conclusion that HaH is a safe and effective alternative for appropriately selected adults, especially older patients with stable chronic disease. So, with the right structure and staffing, HaH can safely provide hospital-level care in patients’ homes around the world.

In 2024, CMS released its review of the Acute Hospital Care at Home (AHCAH) waiver program. CMS found lower mortality and reduced post-discharge Medicare spending in over half of the top 25 diagnosis-related groups [6]. Additionally, rates of hospital-acquired conditions were slightly lower for AHCAH patients, while readmission rates varied by diagnosis [6]. In a related JAMA Health Forum study, among 11,159 AHCAH patients treated over 16 months, only 0.34% died unexpectedly, compared with about 2% of patients in traditional hospital settings [4,5]. However, the CMS study also pointed out clear equity gaps. Patients in the AHCAH were more likely to be white, urban, and higher-income, while rural and lower-income patients were underrepresented. So, the CMS findings suggest HaH can safely replace many hospital stays but that requirements such as safe housing and caregiver support may limit access for those who need it most.

One of the clearest advantages of HaH is its potential to reduce healthcare costs while maintaining high-quality care. Multiple economic evaluations have reported savings ranging from 20-40% per episode compared with standard hospital stays [4,5]. The lower costs may be due to a shorter length of stay and less use of healthcare services, like excess lab tests [7]. However, these estimates may overstate savings because they don’t fully account for fixed hospital costs that persist even when patients are treated at home [8]. Even with strong evidence of cost savings, adoption has been uneven. MedPAC reported that by 2024, 328 hospitals had been approved for the AHCAH waiver [9]. However, fewer than half had submitted active discharge data, suggesting that limited resources and unclear long-term payment policies still limit wider implementation [9]. 

Despite these challenges, patient and caregiver experiences with HaH have been overwhelmingly positive. CMS interviews found that most patients valued the privacy, rest, and convenience of home recovery, while caregivers felt more involved in care decisions. Clinicians also appreciated seeing patients’ home environments, gaining insight into daily habits like diet, mobility, and medication use [6]. Together, these experiences show that HaH maintains quality care while strengthening connections between patients, families, and providers. Overall, the evidence points to a promising future for HaH: the model reduces costs, matches or improves outcomes, and boosts patient satisfaction compared to traditional hospital care. Its long-term success will depend on ensuring equitable access and stable payment systems so hospital care becomes a service delivered at home rather than a place patients must go.

References:

1. Hospital at Home | Johns Hopkins Health Care Solutions. (2010). Johns Hopkins HealthCare Solutions. https://www.johnshopkinssolutions.com/solution/hospital-at-home/

2. Klein, S. (2024). “Hospital at Home” Programs Improve Outcomes, Lower Costs But Face Resistance from Providers and Payers | Commonwealth Fund. Www.commonwealthfund.org. https://www.commonwealthfund.org/publications/newsletter-article/hospital-home-programs-improve-outcomes-lower-costs-face-resistance

3. Levine, D. M., Ouchi, K., Blanchfield, B., Saenz, A., Burke, K., Paz, M., Diamond, K., Pu, C. T., & Schnipper, J. L. (2019). Hospital-Level Care at Home for Acutely Ill Adults. Annals of Internal Medicine, 172(2), 77. https://doi.org/10.7326/m19-0600

4. Adams, D., Wolfe, A. J., Warren, J., Laberge, A., Richards, A. C., Herzer, K., & Fleisher, L. A. (2023). Initial Findings From an Acute Hospital Care at Home Waiver Initiative. JAMA Health Forum, 4(11), e233667. https://doi.org/10.1001/jamahealthforum.2023.3667

5. Arsenault-Lapierre, G., Henein, M., Gaid, D., Le Berre, M., Gore, G., & Vedel, I. (2021). Hospital-at-Home interventions vs in-hospital stay for patients with chronic disease who present to the emergency department. JAMA Network Open, 4(6), e2111568. https://doi.org/10.1001/jamanetworkopen.2021.11568

6. Fact Sheet: Report on the Study of the Acute Hospital Care at Home Initiative | CMS. (2024, August). Cms.gov. https://www.cms.gov/newsroom/fact-sheets/fact-sheet-report-study-acute-hospital-care-home-initiative

7. Saenger, P. M., Ornstein, K. A., Garrido, M. M., Lubetsky, S., Bollens‐Lund, E., DeCherrie, L. V., Leff, B., Siu, A. L., & Federman, A. D. (2022). Cost of home hospitalization versus inpatient hospitalization inclusive of a 30‐day post‐acute period. Journal of the American Geriatrics Society, 70(5), 1374–1383. https://doi.org/10.1111/jgs.17706

8. Goossens, L. M. A., Vemer, P., & Rutten-van Mölken, M. P. M. H. (2020). The risk of overestimating cost savings from hospital-at-home schemes: a literature review. International Journal of Nursing Studies, 103652. https://doi.org/10.1016/j.ijnurstu.2020.103652

9. March 2024 Report to the Congress: Medicare Payment Policy – MedPAC. (n.d.). Www.medpac.gov. https://www.medpac.gov/document/march-2024-report-to-the-congress-medicare-payment-policy/