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

A new article titled “The New Hospital-at-Home Movement: Opportunity or Threat for Patient Care?” by Center for Economic and Policy Research’s Eileen Appelbaum, PhD, and Cornell University’s Rosemary Batt, PhD, has been published in The Gerontological Society of America’s Public Policy & Aging Report. The article is based on a larger report on the topic released by the authors earlier this year. 

In January, Congress extended the hospital-at-home program through 2024. Certified by the Centers for Medicare and Medicaid Services (CMS) in 2020, the program allowed hospitals to treat acutely ill patients in their homes during the COVID-19 pandemic. They received the same reimbursement rates hospitals get for in-patient care, including a “facilities fee” meant to cover the costs of maintaining the hospital. This occurs despite much lower overhead and infrastructure costs of caring for the patient at home. The program required that certain safeguards be met, but relaxed others such as 24/7 RN coverage, while also allowing in-home care to be provided by an RN, a paraprofessional, or an EMT. 

Now healthcare providers and private equity firms that stand to benefit financially from hospital-at-home have organized lobbying groups to make the program permanent for non-crisis conditions. They frame the program as saving costs while increasing patient satisfaction. But Appelbaum and Batt’s research finds that the program allows providers to reduce skilled nursing standards, while also shifting risks and added labor costs to families. 

“Beyond a handful of pre-pandemic small studies, no systematic evidence exists that the current CMS at-home programs provide the same level of care that hospitals provide for the acutely-ill. Too many questions remain unanswered, and CMS lacks the necessary reporting and data systems to ensure provider accountability,” said Batt, the Alice Hanson Cook Professor of Women and Work in the ILR School at Cornell University.

“Who benefits from the cost savings? In the current system, there are too many incentives for hospitals and healthcare companies, as well as opportunistic financial actors such as private equity and venture capital firms, to make money while leaving patients, families, and taxpayers to bear the costs,” said Appelbaum, co-director of the Center for Economic and Policy Research. 

The authors recommend that Congress and the CMS establish a research program to identify best practices and measure their outcomes. Based on this research, appropriate skills and training standards, patient care metrics, and reporting and monitoring systems must be put in place; and cost-sharing standards must be developed so that hospital-at-home programs actually save money while delivering high quality care.

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Public Policy & Aging Report is a publication of The Gerontological Society of America (GSA), the nation's oldest and largest interdisciplinary organization devoted to research, education, and practice in the field of aging. The principal mission of the Society — and its 5,500+ members — is to advance the study of aging and disseminate information among scientists, decision makers, and the general public. GSA’s structure also includes a policy institute, the National Academy on an Aging Society.

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