Why Are Hospital-at-Home Programs Facing Closure? A Deeper Exploration

Becker's Healthcare recently shone the spotlight on a surprising trend: the discontinuation of "hospital-at-home" programs by two significant health systems. Even as the momentum for home-based healthcare grows, both Toledo, Ohio-based ProMedica and Roseville, Calif.-based Adventist Health have chosen to put their programs on hold. The specifics behind these decisions remain a blur, prompting questions about the unseen hurdles these care models might be facing.

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To frame this, we look back to late 2020 when CMS unfurled a waiver to empower hospitals to extend acute care within the confines of a patient's home. A substantial number, nearly 300 hospitals across 125 health systems in 37 states, embraced this opportunity. The model typically identifies eligible ER patients, fits their homes with essential medical tools, ensures routine nurse visits, and coordinates virtual doctor consultations.

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Positioning this against the backdrop of the surge in Medicare Advantage enrollments and the escalating complexity in patient care, hospital-at-home initiatives appear to be crucial. Here's why:

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Backfilling with Higher Acuity Cases: Hospitals can focus on more severe cases, ensuring that resources are utilized where most needed.

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Transitioning Negative Contribution Margin Cases Home: Such cases can benefit from the reduced operational costs of home-based care without compromising on care quality.

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Other compelling motivations include:

• Alleviating the persistent challenge of hospital bed shortages.
• Providing patient-focused care in a comfortable environment.
• Reducing risks like hospital-acquired infections.
• Addressing the needs of an aging population.

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Yet, the closures highlighted by Becker's Healthcare hint at a significant gap: ensuring the 'last mile' of healthcare delivery at home. While the clinical care component is robust, the logistical elements, especially the third-party services like PT/OT on demand, phlebotomy, timely nurse visits, X-rays, ultrasounds, and more, emerge as the weak links.

While some entities are spearheading efforts to transition patients home and monitor them using Remote Patient Monitoring tools, the infrastructure to facilitate in-person services at home is glaringly absent. The lack of efficient delivery of these essential services can potentially result in avoidable re-admissions, negating the very benefits these models aim to achieve. For the hospital-at-home model to fully realize its potential, this gap must be addressed.

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