"Hospital at Home" Programs Improve Outcomes, Lower Costs But Face Resistance from Providers and Payers

Hospital at home programs, which enable patients to receive acute care at home, have proven effective in reducing complications while cutting the cost of care by 30 percent or more, leading to entrepreneurial efforts to promote their use. But widespread adoption of the model in the U.S. has been hampered by physicians' concerns about patient safety, as well as legal risk, and by the reluctance of payers, including Medicare, to reimburse providers for delivering services in home settings. Hospital at home programs that enable patients to receive hospital-level care in the comfort of their homes have flourished in countries with single-payer health systems, but their use in the U.S. has been limited despite compelling evidence that well-monitored, at-home treatment can be safer, cheaper, and more effective than traditional hospital care, especially for patients who are vulnerable to hospital-acquired infections and other complications of inpatient care.