The Hospital at Home (HaH) concept is not new. Developed by Johns Hopkins Schools of Medicine and Public Health, the at-home hospital level services have been in practice since the mid-90s. The dissemination of this HaH model was slow in the United States due to the lack of payer acceptance and physicians’ concerns. But when the healthcare system started buckling under the weight of the COVID-19 surge, the Centers for Medicare & Medicaid Services (CMS) stepped in to allow Medicare-certified hospitals to treat patients with inpatient-level care at home. 

An extension of CMS’ Hospital at Home model, the Acute Hospital Care at Home (AHCaH) program waived the §482.23(b) and (b)(1) of the Medicare Hospital Conditions of Participation, suspending the requirement for 24/7 nursing services to be provided on-premises and for immediate availability of a registered nurse for patient care. As a result of this waiver, Medicare’s hospital at home reimbursement remained the same as it would if care was provided in a traditional hospital setting. 

Leveraging the latest telehealth and remote patient monitoring technology, CMS identified more than 60 acute conditions that could be treated outside of a hospital setting with proper monitoring and treatment protocols. Participating hospitals are also required to adhere to the following medical and non-medical screening protocols before care at home begins:

  • Assessment of working utilities and physical barriers
  • Screenings for domestic violence concerns
  • In-person physician evaluation prior to starting care at home
  • Daily evaluation by a registered nurse in-person or remotely
  • Two in-person visits daily by registered nurses or mobile integrated health paramedics based on the patient’s nursing plan and hospital policies

Challenges and Concerns for AHCaH Adoption

The AHCaH program has gained traction since CMS’ regulatory waiver announcement in November 2020. As of November 2023, the agency approved 305 hospitals for the hospital-at-home model. However, there is still some uncertainty looming around the permanency of CMS’ initiative. Under the 2023 Consolidated Appropriations Act, the initiative has been extended through December 31, 2024.

Here are some of the challenges and concerns surrounding the adoption of the AHCaH program: 


For the first time in 17 years, healthcare leaders ranked personnel shortages as their topmost concern in a survey conducted by the American College of Healthcare Executives in 2021. And a whopping 94% of the CEOs surveyed identified the shortage of registered nurses as the most pressing. 

CMS’ AHCaH requirement for at least two daily in-person visits, specifically by registered nurses, inevitably strains the staffing mechanism. This is exacerbated by the impermanency of the AHCaH program that makes hospitals hesitate to invest in infrastructure and personnel to support at-home care. 

Resistance from Payers

Prior to the public health emergency initiative to waive hospital at home reimbursement conditions, CMS and most private payers did not cover the payments for hospital care delivered at home and generally restricted payments for telemedicine. The lack of payer acceptance has limited the dissemination of this model until the recent CMS announcement. 

Physician Reluctance

Although in principle physicians agree with the hospital at home model, when it comes to deciding to release their patients to be cared for at home, they hesitatechange management being the roadblock.

Among the concerns cited by these healthcare practitioners include their ability to provide the same level of care in a patient’s home. Some also worry about legal repercussions in the event of an adverse outcome when treating patients outside the hospital setting. 

Delivering Value Beyond Hospital Walls 

The COVID-19 pandemic uncovered the importance of value-based care, and CMS’ timely waiver of certain hospital-at-home reimbursement conditions allowed the healthcare system to deliver better value to patients beyond the four hospital walls. 

Telehealth and remote patient monitoring (RPM) has further given healthcare providers the confidence to shift care from hospitals to homes. Tracking a patient’s condition and deciding the appropriate action in real time allows practitioners to manage treatment and adherence with peace of mind. 

Let’s look at how these healthcare providers leveraged telehealth and RPM to reduce costs, length of stay, and readmission rates while maintaining high patient and family member satisfaction levels.

Metro Health – University of Michigan Health 

Mountain Peak


  • Diminishing bed capacity
  • Increasing nurse-to-patient ratios
  • Patient isolation impacts the emotional, mental, and physical health of hospitalized patients
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A telehealth and RPM program focused on COVID-19 mitigation that enabled:

  • 24/7 monitoring of patient vitals and symptoms
  • Improved patient engagement and adherence
  • Enhanced patient-provider communication through HIPAA-compliant virtual visits
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  • Avoided an average of 9.5 days in the hospital for over 80 patients over five months
  • 94% patient satisfaction rate
  • 90% of patients record their vital signs and symptoms daily

Avera Health 

Mountain Peak


  • Diminishing bed capacity
  • Community spread including those experiencing homelessness and non-English speaking communities
  • Limited PPE supplies 
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Leveraged telehealth to enhance Avera’s COVID-19 Care@Home program by:

  • Monitoring patient vitals and symptoms 24/7
  • Conducting daily phone and virtual visits
  • Sharing of daily patient reports with staff physicians to assess for care plan changes
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  • Monitored 3,840 patients from April to November 2020
  • 6.1% hospitalization rate
  • 7.9% Emergency Department visit rate
  • 95% patient satisfaction rate

Achieve Hospital at Home Reimbursement Success with HRS

HRS has helped healthcare providers implement successful telehealth and RPM programs even before the pandemic. Today, with the hospital-at-home initiative becoming a necessity and CMS waiver in place, any concerns surrounding the adoption of the program must be alleviated.  Speak to one of our reimbursement experts to learn how we can help. 

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