A growing number of patients and providers are heralding the benefits of bringing hospital care into private homes — but a lack of permanent federal funding could put such programs at risk.
The shift to in-home care began with the onset of COVID in March 2020, when the Centers for Medicare and Medicaid Services (CMS) launched its Acute Hospital Care at Home waiver program in response to a shortage of beds.
The program enables hospitals to receive the same reimbursement for home care as they would for patients who are treated in actual facilities.
Since the program’s launch, hundreds of hospitals in 37 states have implemented home care for thousands of patients.
One of those is the Mass General Brigham (MGB) network in downtown Boston, which launched its Healthcare at Home program in 2016.
MGB’s Home Hospital is one of the largest in the country, serving 66 neighborhoods from five of its facilities.
Since its launch, the program has had over 2,400 home hospital admissions, translating to more than 12,700 acute care bed days saved, according to a press release from the hospital.
Dr. Stephen Dorner, chief clinical and innovation officer at MGB Healthcare at Home, talked to Fox News Digital about the program’s growth and goals, as well as the benefits for patients and providers.
“In January 2022, we had an average census of nine patients — today, we have an average census of 36 patients with an overall capacity for 40,” he said in a Zoom interview.
“We will continue to grow that in the months and years ahead until we ultimately shift at least 10% of current inpatient volume out of hospitals and into patients’ homes.”
Dorner sees home-based care as a viable solution for the “massive capacity crisis” facing the nation’s hospitals.
“Health care just costs too much money,” he said. “And especially as we look at the aging baby boomer generation and the amount of care they’re going to need — particularly as longevity increases — we have to find new, lower-cost ways to do things.”
The ability to deliver acute inpatient care in people’s homes is a “phenomenal” way to improve overall access to care and reduce medical costs, Dorner noted.
Patients’ demand for home care
While home hospital care isn’t for everyone, many patients are more than willing to receive it.
“The patients who are most willing to accept home hospital care are those who are most in tune and aware of what their medical needs are,” Dorner told Fox News Digital.
“Health care just costs too much money … We have to find new, lower-cost ways to do things.”
That typically includes patients with chronic conditions that may lead to frequent hospitalizations, such as heart failure or chronic obstructive pulmonary disease, he noted.
“They’re more willing to accept home hospital care because they spend so much time dealing with their chronic illness and they’d like to be able to spend more time at home,” the doctor said.
MGB has also had “great success” in admitting patients with new, acute issues that they’ve never dealt with before, such as cellulitis, kidney infection or pneumonia, Dorner added.
“Folks want to have the creature comforts of being in their own bed, eating their own food, petting their dog as they’re recovering, being able to have loved ones come and visit, and not having to trek into the city and pay for parking and all of those things,” he said.
Patients enjoy the personalized nature of in-home care, Dorner also said.
“About 60% to 70% of our visits are actually conducted in the home, not virtually,” he said. “So we’re sending physicians, nurse practitioners and physician assistants into the homes of our patients to be able to see them firsthand, which gives them a unique vantage point of understanding the patients’ home environment.”
He added, “Many of the patients tell us they never want to receive hospital-based care again. They want to know how they can get all of their care from the comfort of their own home.”
The program also has the potential to alleviate provider burnout.
“We’ve heard from our clinicians that the time they spend in home hospital care delivery is among the most meaningful encounters they’ve had in their entire careers,” Dorner said.
That doesn’t mean that all care can be brought into the home, however.
“We’re not building ICUs in the home, and we’re not looking to conduct surgeries in anybody’s living room,” Dorner said.
“But in the right conditions, we’d like to be able to build a complement in the home-based environment.”
“We’re not building ICUs in the home, and we’re not looking to conduct surgeries in anybody’s living room.”
Dr. Shana Johnson, a physical medicine and rehabilitation physician in Scottsdale, Arizona, also voiced her support of the home hospital model.
“With appropriate patient selection, acute hospital care at home is an important care model to continue,” said Johnson, who is not involved with MGB’s program or research.
“For certain medical conditions, the quality of care and outcomes appear equal to or better than in-hospital care,” she added.
“In particular, some studies have found fewer complications from inactivity, such as pressure sores, reduced need for skilled nursing facilities, and lower hospital readmission rates.”
To measure the outcomes of its Home Hospital program, MGB researchers recently conducted a study that was published in Annals of Internal Medicine.
The team analyzed the outcomes of 5,858 U.S. patients who received home hospital care between July 1, 2022, and June 30, 2023.
The patients in the study had “medically complex conditions,” including 42.5% with heart failure, 43.3% with chronic obstructive pulmonary disease, 22.1% with cancer and 16.1% with dementia, the researchers noted.
The five most common discharge diagnoses were heart failure, respiratory infection (including COVID), sepsis, kidney/urinary tract infections and cellulitis.
The researchers found that the patients who received home care had low rates of mortality (0.5% during hospitalization and 3.2% at 30 days). Only 62.2% of them were “escalated” to the hospital.
Within 30 days of discharge, 2.6% used a skilled nursing facility and 15.6% were readmitted, numbers the researchers described as lower than expected.
“Home Hospital is serving very complex and acutely ill patients — these are not ‘cherry-picked’ patients,” study co-author David Michael Levine, M.D., clinical director for research and development for MGB’s Healthcare at Home, told Fox News Digital.
“This is the first time we’ve been able to show the true complexity and acuity of patients cared for in this model on a national basis.”
The researchers also concluded that Home Hospital delivers “equitable care across traditionally underserved populations,” Levine said.
“We know that traditional hospital care has large disparities in outcomes across underserved groups, and we don’t see that with Home Hospital.”
Johnson, who reviewed the findings of MGB’s study, said she found them to be consistent with previous research.
“This study of acute hospital care at home showed low rates of mortality, hospital escalation and skilled nursing facility use,” she told Fox News Digital. “These positive outcomes were seen for socially vulnerable patients as well.”
The study was limited, however, as it was based on observational data and did not have the capability to compare the numbers to in-hospital patients.
“Comparing home hospital patients to traditional hospital patients takes a lot of additional research,” said Levine. “We wouldn’t want to compare home hospital patients to, say, surgical patients or labor and delivery patients.”
He added, “If you simply look at all hospitalizations, yes, these numbers are better — but that is not a worthwhile comparison. We are currently undertaking this more advanced analysis.”
Barriers to home hospital care
Providers are concerned that the Acute Hospital Care at Home program is still a temporary payment mechanism.
The waiver is set to expire in Dec. 2024 unless Congress takes action to extend it or make it permanent.
“A permanent payment mechanism is critical in order for more people to have access to Home Hospital care,” Levine told Fox News Digital.
“We wanted to conduct this national analysis so there would be more data for policymakers and clinicians to make an informed decision about extending or even permanently approving the waiver to extend opportunities for patients to receive care in the comfort of home.”
When contacted for comment, the American Hospital Association (AHA) provided a statement.
“Emerging evidence suggests hospital care at home is safe, effective and useful to many patients. The AHA supported last year’s congressional extension of the regulatory flexibilities that have enabled hospitals to continue their hospital at home programs, and is working to ensure this innovative model of care remains available to patients and communities.”
Fox News Digital reached out to the Centers for Medicare and Medicaid Services (CMS) requesting comment on the potential extension of the Acute Hospital Care at Home waiver program.