By Solveig Dittmann

Although acute level hospital-at-home (HAH) care is not a new concept, its acceptance (and reimbursement for services) is more recent. Care provided through HAH is shown to be up to 38% less expensive than conventional hospital inpatient care and allows physicians to treat patients through telemedicine, digital diagnostic devices, and in-home visits by paramedics or registered nurses. The model’s recent surge of acceptance can be attributed to a perfect storm of factors—including a pandemic-induced lack of hospital beds, advances in remote patient monitoring and telehealth technology, and a Center for Medicare and Medicaid Services waiver.

Leaders are pushing Congress to extend the waiver, which is only in effect for the duration of the current public health emergency, citing the model’s positive impact on health outcomes, costs, and staffing shortages.
Minnesota-based HealthPartners, an organization that began its HAH journey in 2019, reports that patients who participated rate their overall experience as 9/10. HealthPartners has also reported increased availability of inpatient acute care beds since they implemented the program. Other more recent studies show that HAH patients had a 26% lower risk of readmission and a lower risk for long-term care admission. And Mayo Clinic recently reported that HAH patients' 30-day mortality rate is less than 1%, less than the average national inpatient mortality rate of between 2% and 3%.

Quality and cost improvements notwithstanding, organizations considering HAH adoption would be well-served by taking into account these risk factors, which can significantly impact the success of their programs.

1. Has the patient's appropriateness to participate in the program been thoroughly assessed?
Beyond meeting clinical criteria, the care team should take measures to ensure the patient is set up for success at home. First, a thorough assessment should include an in-home environment review. Some programs send a paramedic out before the patient goes home to assess the physical environment and ensure that it is conducive to care, carefully considering the home setting's safety, security, and accessibility. Concerns might include stairs or tripping hazards, for example.

A thorough social assessment is also essential. Here, the focus is on those living at home with the patient, ensuring a support system is in place and securing a commitment that a dedicated caretaker is available for the patient.

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