With Hospital at Home waiver set to expire, patients overwhelmingly support home care

The COVID-19 pandemic forced a reevaluation of health care delivery, pushing providers to embrace telehealth and other remote care solutions to meet patient needs. Recognizing the need for safe access to health care, Congress fast-tracked legislation that expanded Medicare coverage for telehealth services.

Among the initiatives was the U.S. Centers for Medicare & Medicaid Services (CMS) Hospital at Home (HaH) waiver program, which allows enrolled hospitals to receive reimbursement for delivering acute-level hospital care in patients’ homes. To date, 331 hospitals have embraced the initiative, including leading hospitals Mass General Brigham, Mayo Clinic and Mount Sinai Health System.

Still, the program faces a looming expiration at the end of 2024. Proposed legislation aims to extend the flexibility for another five years, yet the program’s future remains uncertain without a permanent solution.

While not without its challenges, such as the need for comprehensive training for patients and caregivers and integration with existing health care systems, at-home acute care has been successfully established and adopted worldwide. Countries such as Australia, the United Kingdom, Spain and Canada have demonstrated the feasibility and benefits of HaH programs.

Although the focus has traditionally been on hospitals’ adoption of the program, recent survey results confirm strong patient preference for at-home hospital care, with 84% saying they’re willing to participate in HaH monitoring to get home sooner. The results reflect patients’ appreciation of the convenience, safety and effectiveness of home-based care, reinforcing its role in health care delivery and urging policy makers to prioritize its continuity.

Rising demand for at-home health care solutions

Conducted by Vivalink, the survey reached more than 1,000 patients over age 40 years, revealing a snapshot of modern care preferences. Most patients (66%) had heard of HaH, and a considerable number had actually taken part in such a program. Specifically, 47% of respondents had participated in HaH patient monitoring — highlighting the rapid rise in popularity and adoption of HaH programs.

Most participants reported positive experiences, with a notable 84% finding at-home monitoring preferable to a traditional hospital stay. The support highlights the growing appeal and effectiveness of HaH programs. Remote patient monitoring (RPM) devices are a key component of HaH programs, contributing significantly to their success. Ease of use also emerged as a critical factor in driving patient satisfaction, with nearly half (49%) finding RPM devices easy to operate.

These patients were monitored for a wide spectrum of conditions. Following hospital discharge, patients were monitored at home for diverse needs, including heart-related issues (46%), cancer recovery (38%) and neurological disorders (38%). The versatility demonstrates how HaH programs are reshaping posthospital care, managing chronic conditions such as diabetes (34%) and addressing acute illnesses like infectious diseases (30%).

Beyond convenience, HaH programs have important benefits for both patients and health care systems. A 2019 study found that patients receiving HaH services cost 38% less to care for than those receiving in-hospital care. These patients had fewer laboratory orders, imaging studies and specialty consultations. They also spent less time sedentary or lying down during the day. Importantly, HaH patients experienced better outcomes, with fewer readmissions than those who received traditional inpatient treatment.

Location and age influences on HaH preference

Age and location significantly influence awareness of and participation in HaH programs, according to the survey. Older patients were notably less likely to have heard of HaH programs than younger patients. Only 42% of respondents over 70 knew of HaH programs, whereas 77% of those in their 40s had heard of them. Similarly, participation rates reflected this trend, with only 11% of older patients having participated in HaH programs, compared with 66% of patients in their 40s.

Urban respondents had higher participation in HaH programs, with 71% participating compared with 25% among rural respondents. However, despite lower participation rates, rural patients showed a stronger preference for mostly remote primary care settings, with 36% preferring this option compared with 19% among urban patients.

Patients with three or more hospitalizations in the past year were notably more receptive to HaH programs, with 95% indicating willingness to participate in HaH monitoring. In comparison, only 62% of those with two or fewer hospitalizations expressed similar openness. While most patients trust their provider’s advice, this trust was particularly strong among those with more hospitalizations, as 95% indicated they would trust their provider’s recommendations for HaH monitoring.

The findings highlight the need to tailor HaH program outreach and implementation strategies based on demographic and health-related factors. Understanding these nuances can enhance the accessibility and acceptance of HaH programs for diverse patient populations, ultimately optimizing health care delivery and patient outcomes.

Influential factors shaping patient acceptance of at-home care

Among the benefits of HaH, the ease and comfort of receiving medical care at home resonate strongly with most patients. According to the survey, 46% of respondents cited the convenience and quality of care at home as their primary reason for preferring HaH after hospital discharge, while 23% emphasized minimizing exposure to infections in hospital environments.

Confidence in RPM devices’ effectiveness and reliability is also critical, highlighted by 18% of respondents. Although only a small portion of patients cited caregiver availability (5%) and access to support services like telehealth and home health aides (5%) as primary reasons for preferring HaH, most patients prioritized the overall convenience and safety of at-home care.

It’s clear that patients value receiving care in familiar environments, as survey results show strong support for HaH programs. As health care evolves, HaH represents a significant move toward more patient-centered care, aligning with patient preferences and improving overall health care outcomes. Policy makers should recognize the value of at-home care and seek to ensure its continuation, meeting the clear demands and needs of patients.

Jiang Li, PhD, is CEO of Vivalink, a Silicon Valley company developing medical wearable sensor solutions for patient monitoring and telemedicine.