Hospital care at home enables patients to receive acute-level care for conditions requiring high-level monitoring—such as acute infection, heart failure or chronic obstructive pulmonary disease—in the comfort of their homes, rather than in hospitals.
For example, there is a program of the Centers for Medicare & Medicaid Services (CMS) that aims to enable this care modality. Launched as the Acute Hospital Care at Home initiative in November 2020 amid the COVID-19 public health emergency, the effort has emerged as a proven approach for Medicare-certified hospitals to provide inpatient-level services to patients requiring around-the-clock care.
How hospital care at home works
While there are other care models in use, the CMS program, in particular, grants waivers to individual hospitals to provide hospital care at home. There are several requirements that participating hospitals must meet. These include:
- Having appropriate screening protocols in place to assess both medical and nonmedical factors before care at home begins.
- Having a physician or other health professional evaluate each patient daily, either in person or remotely.
- Having a registered nurse (RN) evaluate each patient once per day, either in person or remotely.
- Having two in-person visits daily by either a nurse or a mobile integrated health paramedic, whichever is consistent with the RN’s plan and hospital policies.
- Being capable of establishing an on-demand remote audio connection with an Acute Hospital Care at Home team member who can immediately connect the patient to either a physician or an RN.
- Being able to respond to a decompensating patient within 30 minutes.
- Tracking patient-safety metrics with weekly or monthly reporting.
- Creating a safety committee to review patient-safety data.
- Using an accepted patient-leveling process to ensure only patients who require an acute level of care are treated.
- Providing or contracting for additional services required during hospitalization.
Patients are admitted to the program only from emergency departments and inpatient hospital beds, and an in-person physician evaluation is required prior to the start of services.
Why hospital care at home is on the rise
Lawmakers extended the CMS hospital-at-home waiver for five years in early 2026. The move was a big win for patients and physicians—one the AMA fought for to help boost care, cut postdischarge costs and save lives.
Studies, including one in 2024 by CMS, have shown that providing hospital-level care to patients at home results in lower mortality rates, fewer hospital-acquired conditions and substantial cost savings in the 30 days following hospital discharge.
An AMA report, “The State of Health at Home Models: Key Considerations and Opportunities” (PDF), notes that “numerous studies have demonstrated that many types of care that are currently delivered in an office or facility could be provided at home, with clinically appropriate, high quality and cost-effective outcomes.”
Some 15–20% of emergency and urgent-care services, and up to 35% of hospice services, can be administered at home, the report says. And as home care continues to evolve, hospital care at home could provide up to 25% of postacute and long-term care.
Hospital care at home can also help relieve hospital capacity constraints, which can lead to, for example, emergency department boarding of patients. And the care modality enjoys support from patients: A 2022 report by the Linus Group showed that two-thirds of Americans 60–79 wanted to stay at home in their later years.
At the time of the initiative’s extension, more than 350 programs across 139 health systems in 37 states had been approved. Other health systems and hospitals had indicated they were interested in providing hospital care at home but were hesitant to sign up without a longer-term extension.
Encouraging healthcare innovation
There is a growing body of evidence supporting the efficacy of at-home care for patients with chronic or acute conditions, but each patient presents a particular set of circumstances and needs that make standardizing their care challenging.
CMS’ program is just one way to do it. Healthcare organizations that are part of the AMA Health System Member Program—which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine—are developing a variety of clever ways to bring care to patients where they live.
Here are some outstanding examples:
- Atlantic Health examines medicine cabinets at home through its “medicine-cabinet autopsy.”
- Bayhealth brings the clinic to the community with an RV, a mobile health clinic with a private exam room and two screening booths.
- Geisinger taps Geek Squad to elevate chronic care at home by partnering with Best Buy’s Geek Squad.
- Marshfield sees a 44% drop in readmissions with home-recovery program, which was started—in rural Wisconsin—before the COVID-19 public health emergency.
- Ochsner’s digital health program cuts pre-term births by 20% by using digital health tools to offer expectant mothers a convenient way to safely manage their pregnancies in collaboration with their physicians.
- Sanford Health is texting patients directly to stay connected through a low-tech, text-based remote patient-monitoring program.
- The Permanente Medical Group's virtual program makes patients feel right at home by combining home visits, telehealth encounters and remote patient monitoring connected to specialized command centers.
- The Southeast Permanente Medical Group boosts postpartum BP control by 43% by taking a technology-based approach to solve an all-too-common health problem in pregnant and postpartum patients: hypertension.
Hospital care at home in action
The Kaiser Permanente Advanced Care at Home program is an example of what is achievable through the CMS initiative. By combining home visits, telehealth encounters and remote patient monitoring, it achieves a 30-day readmission rate lower than the national average, largely by keeping patients in their homes and connected to the things that are conducive to healing.
While the environment is different for the patient, the role of the physician is the same as it would be for a hospitalist or another hospital-based specialist leading a care team in a traditional brick-and-mortar facility. If a patient needs to be examined, for example, that can be done in coordination with a home health nurse or community paramedic.
Explore other AMA resources on hospital care at home
- Video: “Delivering Health at Home through Innovation and Tech.”
- An overview of the Remote Patient Monitoring Implementation Playbook overview (PDF).
- The state of health at home models: key considerations and opportunities.
- How should physicians sign home care plan of care recertifications?
- Case studies: Digitally enabled care in action
Reviewed by: Jasmine Thekkekara, program specialist in the AMA’s digital health and AI office
