Hospital-level care at home was gaining traction even before the COVID pandemic, and for good reason: A study published in December 2019 in Annals of Internal Medicine showed that hospitalization at home reduced direct acute care costs by roughly 38% and cut 30-day readmissions from 23% among in-hospital patients to 7% in in-home patients.

Necessity, along with regulatory loosening, paved the way for a surge in this type of care with the onset of COVID — a NEJM Catalyst commentary noted that “experts early in the pandemic identified hospital at home as an attractive model for accommodating unprecedented demand for inpatient capacity created by COVID-19, and several health systems began developing pilots.” 

Subsequently, the Centers for Medicare & Medicaid Services (CMS) created the Acute Hospital Care at Home Program to provide a pathway for hospitals to care for acute patients suffering from more than 60 conditions in their own homes.

According to data from the American Hospital Association, as of July 2025, 400 hospitals across 142 systems and 39 states were approved to provide services formally defined as hospital-at-home services to patients. The association noted that others expressed an interest in applying for approval but were reluctant to do so because the program had been set to expire on September 30, 2025.

“(The earlier) lapse of hospital-at-home waivers has caused significant disruption for communities served by hospital-at-home programs,” said Ben Teicher, associate director of media relations for the American Hospital Association.

CMS reported that hospital-at-home programs had served over 31,000 patients in home settings as of October 2024, he said. “Patients have embraced the program and they’re critical for access to care in communities.”

Since the October-November 2025 government shutdown ended, Congress approved an extension of the program through January 30, 2026, but that still leaves most programs in wait-and-see mode.

“A long lapse in waivers may also hamper long-term progress for the hospital-at-home program, which has proven itself as an innovative and promising approach to providing high-quality care,” Teicher said.

Other health systems and hospitals have indicated they are interested in standing up hospital-at-home programs but are hesitant to do so without a long-term extension from Congress, Teicher said.

In the meantime, components of hospital-at-home programs are rapidly expanding across the country, offering acute-level care in patients’ living rooms for conditions like heart failure, chronic obstructive pulmonary disease exacerbations, and infections. What began as a pandemic stopgap has evolved into a permanent feature of inpatient medicine, forcing hospitalists and primary care physicians (PCPs) to rethink where, how, and by whom acute care is delivered.

Coordinating in New Ways

Advocates point to lower readmissions, shorter stays, and high patient satisfaction. But the gains come with new forms of tension as teams grow and change. Eve Cunningham, MD, an obstetrician-gynecologist who until recently was an executive on the health system side with Providence health system, argues scale and integration are the determinants of these models’ efficacy.

“Traditional health systems are not set up to deliver care in the way that we do,” Cunningham, now chief medical officer at care delivery systems company Cadence, said. “It’s the combination of…the partnership approach, the deep clinical integration, and technology integration that is really the secret sauce.” 

Working together in new ways means team members can feel as if they’re walking a tightrope between autonomy and accountability. These teams include clinicians like hospitalists supervising remotely, home-visiting nurses and physician assistants, and virtual pharmacists, while PCPs resume ownership after the most acute phase. Without clear delineation, duplication — or gaps — appear: Who adjusts diuretics when weight spikes? Who responds if a late-day lab value flags critical?

Cadence medical advisor David Feldman, MD, a cardiologist at Massachusetts General Hospital, Boston, said that in these instances, half-solutions backfire.

“We knew that fragmenting a fragmented process was not going to make things better,” he said. Early on, his group stopped using the term remote patient monitoring and moved to remote patient care.

“Monitoring in and of itself is not sufficient — you need to gather the data, assess it, analyze it, and then deliver the care to drive the outcomes you want, including taking care of people at all times, 24/7/365,” he said.

For PCPs and other clinicians waiting for the patients at home to return to in-office visits, the system only works if communication is seamless. Feldman said Cadence teams are synched “with all EMRs [electronic medical records] within every health system,” and have bidirectional messaging so that each entry by every clinician across their system is seen by the patient’s primary care doctor and related specialists in the EMR they use regularly.

Cross-institution data-sharing still has limits, but as Feldman said, that can sometimes be the situation between the surgical service and general medicine in the same hospital.

Why It Matters and the Path Forward

For rural and underserved communities — where hospital closures, specialist scarcity, and long travel times compound risk — home-based acute and longitudinal care may be the only practical expansion path.

“We do a very poor job managing chronic disease in these rural parts of the country,” Feldman said. He said that integrated, always-on teams can “deliver great outcomes, and get [rural patients] to the levels that they deserve.” 

Overall, Feldman said that the success of home-based care depends on treating it like real hospital medicine: continuous, accountable, and ready to act — no matter where the patient’s bed happens to be. Cunningham said that scaling these solutions will require partnership and integration, not piecemeal fixes.

She made the commitment to leave big-system leadership for industry because she believes that the remote care model is “incredibly important for the long-term sustainability of the infrastructure we have within healthcare.”

“This is an important piece of lowering the total cost of care and helping provide critical access…especially in rural and underserved areas.”

Cunningham and Feldman reported being employed by Cadence and having a financial arrangement with the company.