The New Hospital-at-Home Movement: Opportunity or Threat for Patient Care?

Abstract

Existing evidence suggests that a modest number of hospitals have adopted the CMS program, but many more intend to do so now that the waiver has been extended. Two national coalitions have formed to lobby for a permanent waiver program, one led by the American Hospital Association (AHA) and its members and one led by hospitals partnering with HH agencies backed by private equity, venture capital, or hedge funds. They maintain that H@H can lower costs while allowing patients to receive quality care in the comfort of their homes, and they assume that advances in telemedicine and remote monitoring are adequate substitutes for the level of in-person care that hospitals provide (Pelizzari et al., 2022a). Critics include health care professionals and the National Nurses United (NNU), who say that insufficient data exists to compare cost and care quality in H@H and inpatient settings. The NNU cautions that some want to normalize H@H programs largely for financial gain and that new technologies are unproven and poor substitutes for in-person care. Further, H@H programs shift the burden of labor costs from hospitals to patients’ families while also replacing registered nurses (RNs) with lower-skilled emergency medical technicians (EMTs) or paramedics, thereby de-professionalizing health care services (National Nurses United, 2022).