The Health Management Academy

What’s Keeping Health Systems from Scaling Hospital-at-Home?


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Digitally-enabled home-based care models have gotten a lot of attention from Leading Health Systems (LHS) as they look to develop more consumer-friendly services.

In particular, interest in the hospital-at-home has rocketed during the pandemic, in large part because it’s provided a safe alternative to busy inpatient units – and because CMS introduced a waiver that paved the way for reimbursement.

Meeting patients where they are, and more affordably, appears to be a winning strategy. But the reality is most hospital-at-home programs remain subscale, often with daily use in the single digits. Without the appropriate scale, it’s difficult to see the model lasting beyond the pandemic.

Here are the top five factors keeping LHS from scaling their hospital-at-home programs:

  1. Low patient enrollment: Limiting eligible patients to those originating in the ED or inpatient settings stifles patient volumes from non-acute, urgent care settings. It also places the burden of identifying potential enrollees on ED physicians and nurses.
  2. Staffing challenges: Finding the right mix of skills and background, combined with a sufficient number of providers, adds complexity amid today’s severe workforce shortages. Hospital-at-home staff need experience with inpatient-level acuity coupled with comfort working autonomously and with virtual care platforms.
  3. Provider support: Broad geographic distribution of patients, concerns around safety in an “uncontrolled setting,” and issues with technology interoperability introduce additional stress to providers.
  4. Coordination of services: Transporting providers and equipment when needed adds complexity to care coordination and delivery. Many health systems struggle to provide ancillary services, such as lab, imaging, and pharmacy to hospital-at-home patients.
  5. Reimbursement uncertainty: Lack of widespread private payer interest and the temporary nature of the CMS waiver providing payment parity (with inpatient care) have led to concerns around long-term financial sustainability of the hospital-at-home care model.