CMS’ Acute Hospital Care At Home Waiver Delivers Promising Results

Since the Centers for Medicare & Medicaid Services (CMS) launched the Acute Hospital Care at Home waiver in response to the COVID-19 pandemic, patient outcomes have been encouraging.

Of the 11,159 patients who received care from November 2021 to March 2023, only 7.2% of patients that were being treated in the home were transferred to the hospital, according to a recent study published by JAMA.

Only 38 unexpected deaths were reported, which accounted for about 0.34% patients. Most of those deaths were due to the progression of COVID-19 symptoms.


Those are solid results, particularly for a waiver that came about suddenly due to a national emergency. Since 2021, more and more hospitals have begun delivering home-based hospital care, both inside and outside of the waiver.

As of Nov. 8, 128 health systems and 304 hospitals in 37 States had been approved to deliver care underneath the waiver.

“Patients who received care under AHCAH had a low mortality rate consistent with the hospital-at-home literature and minimal complications related to escalations back to the brick-and-mortar hospital,” the study read. “In addition to increased federal oversight, study limitations include that there may have been substantial selection bias from hospitals that chose to participate and patients who had medical conditions for which care could be provided in their homes. This pattern may be related to the safeguards inherent in the Medicare Hospital COP that have remained in place since the inception of AHCAH, appropriate patient selection, and the federal and local oversight incorporated into the initiative.”


Health systems ramping up hospital-at-home programs have reported similar results in conversations with Home Health Care News.

Most recently, Mass General Brigham partnered with Best Buy Health to further its hospital-at-home capabilities.

Dr. Stephen Dorner, the chief clinical and innovation officer at Mass General Brigham Healthcare at Home, told HHCN that it planned to have 10% of its patient beds underneath a hospital-at-home construct in the near-term future.

“America’s hospitals are crowded with patients often waiting hours, if not days, in hallways and emergency departments to receive their inpatient care,” Dorner said. “Mass General Brigham hospitals experience this burden on a daily basis. Home hospitalization provides a way to respond to the capacity crisis, improving access to care through a more patient-centered delivery model that is also lower cost than traditional care. Embracing all of those benefits, the expansion of Home Hospital is one of Mass General Brigham’s strategic priorities.”

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