The recent extension of COVID-19-era regulations by President Trump has provided a lifeline for telehealth and hospital-at-home services, but healthcare organizations remain frustrated by the ongoing uncertainty surrounding these initiatives. The extension allows for the continuation of flexibilities that have been crucial in expanding telehealth services, including removing geographic boundaries, allowing audio-only visits, and extending services for Federally Qualified Health Centers and Rural Health Clinics.
The hospital-at-home waiver, known as the Acute Hospital Care at Home initiative, has also been extended, enabling full reimbursement for Medicare patients receiving hospital-level care at home. This initiative has garnered bipartisan support, with providers and researchers showcasing the positive impact it has had on patient care and outcomes.
Despite the extensions, healthcare executives are wary of the temporary nature of these measures, which hinders their ability to make long-term plans and investments in telehealth and hospital-at-home programs. The uncertainty surrounding reimbursement and regulatory changes has dampened the appetite for scaling these initiatives and integrating them permanently into the healthcare system.
As of March 17, 2025, 400 hospitals within 143 health systems across 39 states have been granted waivers for hospital-at-home programs by CMS. While some providers have embraced these programs and seen positive results, others are hesitant to invest substantially without the assurance of long-term stability.
The economic benefits of hospital-at-home programs are significant, including relief of capacity constraints, capital avoidance, and stand-alone profitability. Furthermore, the non-economic benefits, such as improved patient care and satisfaction, are equally important in driving the adoption of these programs.
Health systems are now exploring the expansion of hospital-at-home infrastructure to other care-at-home models, such as observation at home, emergency services at home, and post-acute care. These models offer a cost-effective and efficient way to deliver care to patients in their homes, addressing the growing demand for home-based healthcare services.
Despite the challenges and uncertainties, the hospital-at-home “movement” is gaining momentum, with providers, regulators, payers, and technology vendors working together to accelerate its adoption. A long-term extension of the CMS waiver, along with program refinements and operational improvements, will be crucial in ensuring the success and sustainability of hospital-at-home programs in the future.
In conclusion, while the road ahead may be uncertain, the benefits of hospital-at-home programs are clear. By continuing to innovate, collaborate, and adapt to changing healthcare landscapes, health systems can build a more resilient and patient-centered care delivery ecosystem that meets the needs of patients and providers alike.
