Clinician Comfort Level, Reimbursement Remain Key Challenges For Hospital At Home

In the view of most health care stakeholders, the hospital-at-home model is here to stay. Still, there are many hurdles that could still prevent widespread adoption.

One of these challenges is clinician comfort with the model, according to Ross Armstrong, chief commercial officer at Biofourmis.

“‘Am I going to put my license at risk, if I refer a patient into this model?’” he said during a panel discussion at the Hi2 conference earlier this month. “‘Is somebody going to be there to accept the patient whenever they arrive?’ From a patient perspective, I think conditioning them around this as a high-quality model of care isn’t something we’ve done a good job in.”


The Boston-based Biofourmis is a technology-focused at-home care enabler.

Ross also pointed out that the hospital-at-home space requires advancements in reimbursement mechanisms.

“This was part of the public health emergency, that’s where the waiver came from,” he said. “Yes, it’s been extended to the end of 2024, but the reality is there’s still a lot of uncertainty around it. It hasn’t been extended past that.”


Outside of traditional Medicare, health plans are all over the map when it comes to where they land on reimbursing the model.

Additionally, there are many moving parts when operating a hospital-at-home program.

“The logistics piece isn’t easy,” Armstrong said. “There are 15 different services that have to be delivered in the home. The reality is that the core services of a hospital are not necessarily logistical services. Typically, a hospital doesn’t do all 15 of these services, so you’re creating an ecosystem where you have to manage vendors, and that’s not easy to do.”

Dr. Jared Conley — the assistant director of the health care transformation lab at Massachusetts General Hospital — thinks that the goal should be to reach a point where a home-centered acute health care system is the norm.

“That’s kind of what we’re aiming for,” Conley said during the discussion. “How do you build out those payment models? The Australians have been [doing it] for over a decade. It does make sense to think at least about a payment parity when you see a lot less spent potentially on the post-acute side.”

Boston-based Massachusetts General Hospital is the largest teaching hospital of Harvard Medical School.

Looking ahead, Lisa Fry, president of value-based care at SCP Health, believes that hospital at home will be a key space to invest in.

“There’s a very large addressable market, it’s largely untapped, so there’s a huge growth potential for that,” she said. “Roughly 30% of the admissions in America could be done as a hospital at home-based admission.”

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