The U.S. Experience: From Waiver to Mainstream

In the United States, the adoption of Hospital-at-Home was significantly accelerated by the COVID-19 pandemic. In November 2020, the Centers for Medicare and Medicaid Services (CMS) launched the Acute Hospital Care at Home program, providing a waiver that allowed certain Medicare-certified hospitals to deliver acute-level care at home. This waiver has been instrumental in expanding access to HaH and has fueled significant investment and innovation in the sector.

The U.S. model often involves a multi-disciplinary team, including physicians, nurses, paramedics, and other allied health professionals, who provide in-person and virtual visits. Remote patient monitoring (RPM) devices are crucial, automatically transmitting vital signs and other data to a hospital-based care team for 24/7 oversight. For conditions like heart failure, COPD, pneumonia, and certain infections, HaH has proven to be a safe and effective alternative to traditional hospitalization.

While the CMS waiver has been critical, challenges remain, particularly around consistent reimbursement models and regulatory frameworks that can vary by state. However, the demonstrated benefits—including lower readmission rates, improved patient outcomes, and reduced healthcare costs—are pushing HaH towards becoming a more permanent and integrated component of the U.S. healthcare system. Efforts are underway to extend and solidify the legal and financial foundation for HaH programs.

Key Aspects of the U.S. Model:

• CMS Waiver Program: Provided a crucial regulatory pathway for expansion during the pandemic.
• Telemedicine & Remote Patient Monitoring: Integral components for daily oversight and intervention.
• Focus on Specific Conditions: Often targets acute conditions suitable for home-based management.
• Ongoing Advocacy for Permanent Integration: Healthcare leaders are pushing for long-term policy solutions.

Related Literature & Sources:

• BioSupply Trends Quarterly Magazine – Hospital at Home: The Future of Care?: Discusses the evolution of HaH in the U.S. and its future potential. https://www.bstquarterly.com/article/hospital-at-home-the-future-of-care/
• NTT DATA – The six biggest challenges of the Hospital at Home care model: Explores the challenges of implementing HaH, including financial and regulatory hurdles in the U.S. context. https://us.nttdata.com/en/blog/2023/december/the-six-biggest-challenges-of-the-hospital-at-home-care-model