New research shows hospital at home offers demonstrable benefits over traditional inpatient care for patients and providers alike, but getting the most out of these services requires technological, operational, and workforce adjustments.
Across service lines and treatment categories, there’s a paradigm shift nearly a decade in the making: Inpatient is out, outpatient is in.
As patient preferences continue to follow those of consumers at large, at-home care is a logical terminus of the trend toward more accessible, personalized, and convenient healthcare services.
Hospital at home—the delivery of hospital-level care in patients’ residences—represents some of the most intensive care patients can receive at home. For providers and companies selling into healthcare, it also represents an expansion of an addressable market once contained by facility walls.
While delivering acute care outside of hospital settings presents technological, operational, and workforce challenges, a growing body of research shows that downstream benefits associated with hospital at home could ultimately improve health outcomes and reduce total healthcare spending.
Patients do better under hospital at home
A new study led by University of Iowa researchers and published in JAMA Network Open found that hospital at home services were associated with significantly lower in-hospital mortality and emergency department use. That’s great news for patients and providers, as well as for the organizations that support both.
Not only is emergency department usage resource-intensive for providers, but up to 1 in 5 expected payments for ED physicians goes unpaid, potentially cutting into revenue and operational budgets.
Additionally, the Hospital Value-Based Purchasing Program rewards hospitals for reducing mortality rates and improving care transitions. With evidence showing that hospital at home can support these metrics, there could be a strong financial case for certain providers to expand their home care offerings.
Overcoming the reimbursement barrier
The cost efficacy of hospital at home varies from provider to provider and from patient to patient.
Providers serving a larger population of appropriate inpatient-level patients can quickly realize the savings potential in hospital at home. Patients who only need more limited visitation from a clinical team rather than round-the-clock care present significant cost savings when kept out of high-overhead facilities where beds are at a premium.
However, for patients requiring higher-acuity care involving a broader clinical team and more complex modalities and technologies of inpatient care, hospital at home may be more costly to the provider up front. Historically, a lack of Medicaid and Medicare reimbursement options for at-home care have forced providers to limit these services to select patients with participating private payers or those paying out of pocket.
But in the fall of 2020, inpatient capacity shortages caused by COVID-19 led the Centers for Medicare and Medicaid Services (CMS) to offer reimbursement for care services received in the home. At the time of writing, the Acute Hospital Care at Home (AHCAH) initiative extends reimbursement opportunities for certain hospital services outside of traditional care facilities until September 30, 2030.
With a wider variety of services now considered billable by CMS, and a growing number of private offering reimbursement, there can be an economic case to provide hospital at home. But that doesn’t mean it’s easy.
Providers need support adapting to home-based care
Traditionally, expanding capacity—whether across a network or within specific service lines—meant adding beds, hiring new staff, installing necessary technologies, and building or acquiring new facilities. Delivering hospital care at home creates additional layers of complexity in this process.
Workforce readiness
The average hospital staffing model is built around a single location—although centralized, network-level staffing and float pools are becoming increasingly common amid the ongoing labor shortage. Staffing needs are then usually determined among distinct units, each containing multiple patients unified by acuity levels or specialized care needs.
Because hospital at home distributes patients geographically, the distance traveled between patient visits is measurable in miles rather than meters. This shakes up the calculus of nurse-to-patient ratios and hours per patient day significantly, requiring workforce planning to incorporate new logistical considerations that go beyond “one HCP = X beds of coverage.”
Technology
Remote monitoring via connected medical devices and virtual care are rapidly becoming central parts of clinical infrastructure. An investment in hospital at home may require expanding these capabilities through increased networking speed/capacity, more robust cybersecurity measures, smarter EHR integration and data management, and higher rates of communication with offsite patients.
On the patients’ end, providers will need to ensure patients assigned to hospital at home are equipped with both the in-residence technologies required to support their treatment as well as the knowledge and willingness to effectively engage with them. This likely means doubling down on patient education efforts and compliance oversight, whether led by the visiting HCP, a telehealth provider, or additional support staff.
Capacity and operations
When it’s working well, hospital at home enables providers to free up inpatient beds for patients who truly need in-facility care, extend capacity in underserved markets, and shift appropriate patients to lower-cost settings.
But not all patients are appropriate for hospital at home. Some patients require a level of round-the-clock acuity that can’t easily be delivered in the home. And other patients who are medically suited to at-home care may live in residences that are themselves inappropriate or unsafe for care delivery.
These factors add new wrinkles to existing workflows—or may create new workflows entirely—related to patient selection, admissions and onboarding, medication delivery and adherence, compliance, discharge, care coordination… essentially, every aspect of a hospital’s operational strategy.
Ready to invest in hospital at home? Ask the right questions
To gauge the cost and impact of hospital at home expansion, providers—and the vendors that support them—need to ask the right questions:
- Which patients could be treated at home? And where are they located?
- What portion of care can be provided at home via telehealth versus in-person HCPs?
- Where are competing health systems developing home-based programs?
- What services are disproportionately migrating from inpatient/outpatient facilities to home settings?
- Where are the biggest geographic gaps in home-based care?
- Is our technology stack prepared to support at-home care effectively, safely, and compliantly?
The fastest, most effective way to answer these questions is by leveraging a robust dataset and powerful analytical tools. Procedural and diagnostic claims, provider reference and affiliations data, technology installations, and consumer- and market-level intelligence all offer deep insights that can shape strategies around hospital at home and other service line growth opportunities.
Definitive Healthcare offers data and analytics solutions tailored to the unique needs of healthcare providers, as well as the technology, staffing, and consulting organizations that support them.
Book a demo today to see our data and get a firsthand look at the unique insights only we can offer.
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