Hospital At Home Faces ‘Wait-And-See’ Moment Amid Waiver Uncertainty

Last week, Best Buy Health announced during an earnings call that it was restructuring its health division due to the slow adoption of at-home care. CEO Corie Barry specifically pointed to its hospital at home (HaH) program as an issue because of “inconsistencies” in the duration the Acute Hospital Care at Home program, currently set to expire in September.

While Best Buy Health is feeling the impact of uncertainty surrounding the HaH waiver program, health systems that have yet to launch HaH programs are hesitating amid questions about its long-term future. Still, industry experts remain optimistic about HaH’s future, even as they acknowledge that the path to a permanent HaH policy is fraught with challenges.

“The movement is stronger than ever,” Dr. Robert Moskowitz, president and chief medical officer at Contessa Health, told Home Health Care News. “Hospital capacity issues have not improved, and the viability of rural hospitals continues to be at risk. The factors that created the need for hospital-at-home programs continue to underscore the importance of the movement.”

Contessa Health has provided comprehensive in-home care since 2015. The company is headquartered in Nashville, Tennessee, and collaborates with 11 health systems and various health plans, serving patients across nine states.

Hospitals have used the HaH model since the mid-2000s. In 2020, the Centers for Medicare & Medicaid Services (CMS) launched the Acute Hospital Care at Home program, allowing hospitals to qualify for Medicare waivers to treat patients at home via telehealth. The waiver program has since been extended multiple times.

As of March 2025, 391 health care facilities across 39 states have been approved to provide HaH services, according to the American Hospital Association.

HaH is now entering a new phase, according to Dr. Michael Maniaci, enterprise medical director of virtual care at the Center for Digital Health at Mayo Clinic.

“While the initial pandemic-era surge in hospital-at-home enthusiasm has naturally leveled off, what we’re seeing now is a shift from broad experimentation to targeted refinement and scaling,” Maniaci told HHCN. “The movement hasn’t lost momentum; it’s entering a more disciplined and strategic phase.”

Major health systems, including the Mayo Clinic and Boston’s Mass General Brigham (MGB), have already integrated HaH into enterprise-level operational planning, aligning it with virtual care, command centers and decentralized delivery models.

“National conversations have matured,” Maniaci said. “We’re no longer asking ‘Can we do HaH?’ We’re asking, ‘How do we make it more efficient, sustainable and the new normal?”’

The Mayo Clinic Health System has dozens of locations in several states, including major campuses in Rochester, Minnesota, Scottsdale and Phoenix, Arizona, and Jacksonville, Florida.

An uncertain future

Hundreds of health systems have adopted the HaH model through CMS’ waiver program, but further adoption may be hampered by continued short-term extensions rather than a single, more permanent policy.

“One of the key issues with continued short-term extensions is that it is causing hospitals without home hospital care to delay their initial investment in launching their own program,” Dr. Stephen Dorner, chief clinical and innovation officer for Mass General Brigham Healthcare at Home said. “That is why we continue to advocate for a long-term extension to ensure that this high-quality, patient-centric care model continues to be adopted by more hospitals nationwide.”

The road to a long-term extension or permanent policy is not without its challenges.

A “crowded policy landscape” is among the factors hampering the establishment of a permanent policy, according to Dorner.

“There is currently a wide range of competing legislative priorities – from Medicaid considerations to tax reform – and it simply takes time for any new care model to find its footing,” he said. “But home hospital care has consistently shown up in every legislative package since the end of the public health emergency, with growing bipartisan backing.”

Another hurdle complicating the permanent implementation of the waiver is that HaH does not clearly fit into the current regulatory and reimbursement infrastructure.

“Hospital at home challenges traditional definitions of what it means to be hospitalized, and that disrupts deeply entrenched billing structures, site-of-care rules and legacy infrastructure,” Maniaci said. “CMS and policymakers are navigating the need for safety, equity and fraud prevention, while also grappling with the inertia of a hospital-centric payment model.”

Another issue is that HaH programs differ in intensity, staffing, technology use and outcomes, he said. This variability makes it difficult to create a one-size-fits-all permanent policy. Maniaci is in favor of a tiered, outcomes-based framework that allows flexibility while holding programs accountable to safety, quality and cost benchmarks is necessary.

A focus on outcomes drove the creation of the initial waiver and will be crucial in the development of a permanent policy, according to Caroline Rogers, senior vice president of quality and safety at Contessa Health.

“Data appropriately drive permanent policy decisions – both clinical and economical,” Rogers told HHCN. “A critical element of last year’s proposed five-year waiver extension, which had bipartisan and bicameral support, included the requirement for more robust data collection and analysis. This requirement will likely remain with the reintroduction of waiver extension legislation and is still the next logical step toward the development of a permanent policy.”

While data is a critical element of HaH, the technology necessary to collect and analyze data, such as remote patient monitoring, requires significant infrastructure and resources. A lack of federal support for the program could make it difficult for operators to invest in robust data systems, potentially resulting in reduced backing from commercial health plans.

Without this support, health systems will likely struggle to invest in HaH programs, slowing adoption.

Without an extension or the implementation of a permanent policy, the waiver will expire in September, requiring health systems to transfer patients back into their physical facilities immediately. This would strain hospital capacity, according to Rogers.

The clinical case is clear, and the operational model is functioning well, according to Dorner. The policy signals, – specifically inclusion in federal proposals, CMS engagement and cross-sector collaboration between health care and industry, – are all progressing positively.

“It’s not a question of if, but when,” he stated. “And when it happens, the systems that have done the hard work will be ready.”

On its end, MGB is not solely advocating for the preservation of the waiver, but also for creating “augmented capacity” by providing patient care in their homes, allowing brick-and-mortar hospitals to meet the needs of those patients who need them most, according to Dorner.

Adapting to uncertainty

Despite waiver uncertainty, “smart” organizations will continue to expand HaH programs, according to Maniaci.

To do so, health systems are diversifying their HaH offerings, Maniaci said. Strategies include forming payer partnerships outside of fee-for-service Medicare, piloting bundled or value-based contracts and investing in care models that are flexible between waiver and non-waiver states.

For example, the Mayo Clinic has intentionally created a modular system, called Advanced Care at Home, that scales across various geographies and operates within different regulatory frameworks. It is also incorporating HaH into bed capacity planning and facility expansion strategies, Maniaci said.

“Across the country, hospitals are refining their models, integrating more deeply with health systems and demonstrating with real situational data that home-based acute care provides safer, more patient-centered outcomes,” Dorner said. “In our case, we’re evolving from a start-up phase into a core service line. That kind of shift might appear quieter from the outside, but it signals a lasting transformation that we and many others across the country are undertaking.”

Still, Maniaci admitted that uncertainty leads to tough decisions and that health systems that were undecided about HaH are hesitating. Others are stalling on capital investment.

The lack of permanence is creating a “wait and see” environment that hinders innovation, Maniaci said. Despite that, the organizations that view HaH as part of a long-term shift toward decentralized, digitally enabled care are continuing to push forward.

“For those who have already committed to HaH as a core system focus, it is full steam ahead,” Moskowitz said. “But this also includes adapting or creating HaH models that can function outside of the CMS waiver. This can happen by contracting directly with payers. Alternatively, we see models that focus on hospital avoidance, early discharge, skilled nursing care at home, and palliative care at home – approaches that shift high-acuity care options safely and effectively to patients’ homes instead of inpatient care.”