In most of American healthcare, finding consensus is nearly impossible. Democrats and Republicans rarely agree on policy. Hospitals and insurers often clash. Physicians and administrators see issues from different angles. But there’s one program that has managed to unite nearly everyone: Hospital at Home.
In July 2025, Congressman Vern Buchanan, Chair of the Health Subcommittee on Ways and Means, introduced the Hospital Inpatient Services Modernization Act (H.R. 4950) alongside Representatives Lloyd Smucker (R-Pa.) and Dwight Evans (D-Pa.), with companion legislation (S. 2346) introduced in the Senate by Tim Scott (R-S.C.) and Reverend Raphael Warnock (D-Ga.) The bipartisan legislation, currently pending in committee, aims to extend Hospital at Home programs for an additional five years—but there’s urgency behind this push. Without congressional action, the waivers enabling these programs are set to expire on September 30, 2025, as indicated in the most recent temporary extension legislation.
For physicians, this legislative battle isn’t just about policy abstractions. It’s about whether a care delivery model that’s been proven to improve outcomes, reduce costs, and increase patient satisfaction will survive—and how that survival might reshape medical practice in the coming years.
The Pandemic Innovation That Worked
Hospital at Home wasn’t born from careful planning or years of pilot programs. It emerged from desperation. In November 2020, the Centers for Medicare & Medicaid Services established the Acute Hospital Care at Home waiver program as hospitals across the country faced overwhelming patient volumes during the COVID-19 pandemic. The concept was straightforward: allow hospitals to provide acute-level inpatient care to patients in their own homes, with the same Medicare reimbursement they would receive for traditional hospital care.
What started as an emergency measure quickly demonstrated results that surprised even its advocates. Researchers tested the concept at several Medicare managed care sites and reported a cost savings of about 30% compared with traditional inpatient care, better clinical outcomes, lower average length of stay, and fewer lab and diagnostic tests. Multiple program evaluations from CMS and participating health systems have documented cost reductions in this range, though specific savings vary by program design, patient population, and cost accounting methodology.
The program’s growth tells the story of its success. According to CMS approved provider lists and American Hospital Association tracking, over 300 hospitals across numerous health systems in more than 30 states had been approved to provide Hospital at Home services as of mid-2025. This rapid expansion occurred not because of regulatory mandates, but because hospitals saw genuine clinical and financial benefits.
The Clinical Evidence: Better Outcomes, Fewer Complications
For physicians evaluating any new care model, the first question is always: Does it work? With Hospital at Home, the accumulating evidence is compelling.
Research on Hospital at Home programs has documented substantially lower readmission rates, reduced medication errors, and fewer adverse safety events compared to traditional inpatient care. Multiple studies across different patient populations have shown that carefully selected patients can receive acute-level care at home with outcomes that meet or exceed traditional hospital care. Program evaluations have documented both significant cost savings per admission and equivalent or improved clinical outcomes with fewer complications than traditional hospital care.
The reduction in unnecessary testing is particularly significant. In traditional hospital settings, the availability of diagnostic services often leads to their overuse. When care shifts to the home, physicians become more selective, ordering only tests that will genuinely change management.
The model’s potential scope is substantial. Research and program evaluations suggest that a meaningful portion of emergency department visits, certain post-acute care services, and some hospice services could potentially be delivered safely at home with appropriate protocols and monitoring technology. As technology and care protocols continue to evolve, estimates suggest this approach could address a significant share of post-acute and some long-term care needs in home settings.
Why the Legislative Urgency?
Since the start of the program, Congress has extended it three times: first in 2022 (Consolidated Appropriations Act of 2023) for two years, then again in 2024 (H.R. 10545, the American Relief Act) for 90 days, and most recently in 2025 (H.R. 1968, the Full-Year Continuing Appropriations and Extensions Act) for six months. Each extension has been temporary, creating uncertainty for hospitals considering investments in Hospital at Home infrastructure.
This pattern of short-term extensions creates a significant problem. Hospitals interested in launching Hospital at Home programs face substantial startup costs: hiring specialized staff, developing protocols, acquiring monitoring equipment, and training clinical teams. 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.
The September 30, 2025, deadline adds urgency. Without action, hundreds of existing programs serving thousands of patients could face sudden termination. The proposed five-year extension would provide the stability needed for both existing programs to solidify and new programs to launch.
What It Means for Physician Practice
Hospital at Home fundamentally changes how physicians approach acute care. In traditional inpatient settings, physicians make brief visits to patients, reviewing nursing notes and diagnostic results before moving to the next room. The hospital environment creates physical proximity but often emotional distance.
Home-based acute care inverts this dynamic. Physicians or advanced practice providers make house calls, seeing patients in their own environments. This provides clinical information unavailable in hospitals—how patients actually live, what their home support systems look like, what barriers might affect recovery and adherence.
The model relies heavily on remote monitoring technology. Patients receive equipment that continuously tracks vital signs, sending alerts when parameters fall outside normal ranges. This allows for early intervention before complications develop. For physicians, it means managing patients through a combination of in-person visits, telehealth check-ins, and real-time data review.
The payment structure matters significantly. Hospital at Home receives the same Medicare reimbursement as traditional inpatient care—not the lower rates typically associated with home health. This recognition that patients are receiving acute-level care, just in a different setting, makes the economics work for hospitals while maintaining physician compensation.
Implementation Challenges and Considerations
Not every patient is appropriate for Hospital at Home. CMS program requirements and clinical guidelines specify exclusion criteria, typically including patients requiring intensive care, those with certain complex conditions requiring continuous monitoring unavailable in home settings, or those lacking adequate home support and safety conditions. Patient selection protocols are crucial—sending the wrong patient home can lead to poor outcomes and emergency transfers back to the hospital.
Physician liability is another consideration. When complications occur at home, determining whether appropriate monitoring and response occurred becomes more complex than in a hospital, where nursing staff provide continuous observation. Clear protocols, thorough documentation, and robust communication systems help mitigate these risks, but they represent new considerations for physicians accustomed to traditional inpatient care.
State Medicaid coverage for Hospital at Home remains limited and varies significantly by state. According to tracking by Better Care Playbook and state Medicaid agencies, a limited number of state Medicaid programs currently cover hospital-at-home care for Medicaid fee-for-service enrollees. States that have implemented some form of coverage include Massachusetts, New York, Oregon, Michigan, North Carolina, and several others, but the patchwork nature of state decisions creates geographic inequities. This creates a disparity where Medicare beneficiaries have broader access to Hospital at Home, while many Medicaid patients don’t—a concern for advocates of health equity.
The Broader Healthcare Transformation
Hospital at Home represents more than just an alternative care setting—it signals a broader shift in how healthcare is delivered. Survey results suggest that roughly 20 to 30 percent of additional Medicare FFS and MA spending for acute care can be delivered at home. If even a portion of this potential is realized, it would represent a substantial restructuring of acute care delivery.
For physicians, this transformation creates both opportunities and challenges. Opportunities include greater flexibility in practice models, closer relationships with patients through home visits, and participation in innovative care delivery. Challenges include adapting to new technologies, managing care with fewer immediately available resources than hospitals provide, and navigating evolving payment and regulatory structures.
The American Hospital Association has strongly supported the extension. According to an AHA fact sheet, “A long-term extension will not only provide additional time to continue gathering data on quality improvement, cost savings, and patient experience, but will also provide much-needed stability for new programs and may ease state concerns about updating Medicaid policies to allow for coverage of these services.”
What Happens Next
The Hospital Inpatient Services Modernization Act faces the challenge all legislation faces: navigating Congressional politics and competing priorities. The bill has been referred to a committee and awaits further action. Its bipartisan sponsorship and track record of successful short-term extensions suggest reasonable prospects, though passage is not guaranteed and timing remains uncertain.
For physicians, several scenarios are possible. If a multi-year extension passes, Hospital at Home programs will likely expand significantly, creating new practice opportunities and potentially shifting where acute care physicians work. Medical training programs may begin incorporating Hospital at Home rotations, preparing the next generation of physicians for home-based acute care delivery.
If the extension fails and programs terminate on September 30, it would represent a rare case of evidence-based medicine being abandoned despite demonstrated success. The consequences would extend beyond the programs themselves to the patients who benefit from home-based care and the healthcare systems that have invested in this model.
The most likely scenario involves passage of some form of extension, allowing programs to continue while Congress gathers additional data and considers permanent authorization or further refinements to the program structure.
The Stakes for Healthcare Delivery
Hospital at Home sits at the intersection of multiple healthcare trends: the shift toward value-based care, the integration of remote monitoring technology, the emphasis on patient-centered care, and the need to reduce costs while improving outcomes. Its continuation or termination will influence how aggressively healthcare pursues similar innovations.
For physicians considering their career trajectories, understanding Hospital at Home matters whether or not they participate directly. The model’s expansion affects hospital capacity, changes referral patterns, and demonstrates that acute care doesn’t require traditional hospital buildings. These shifts have implications across specialties and practice settings.
The September 30 deadline approaches. Whether Congress acts in time will determine not just the fate of current Hospital at Home programs, but whether American healthcare continues down a path of innovation in care delivery or retreats to traditional models despite evidence supporting change.
Sources:
- Buchanan, V. (July 10, 2025). “Buchanan Introduces Bipartisan, Bicameral Legislation to Extend Successful ‘Hospital at Home’ Programs.” Press release. https://buchanan.house.gov/2025/7/buchanan-introduces-bipartisan-bicameral-legislation-to-extend-successful-hospital-at-home-programs
- U.S. Congress. H.R. 4950 – Hospital Inpatient Services Modernization Act of 2025. 119th Congress (2025-2026). https://www.congress.gov/bill/119th-congress/house-bill/4950
- U.S. Congress. S. 2346 – Hospital Inpatient Services Modernization Act of 2025. 119th Congress (2025-2026). https://www.congress.gov/bill/119th-congress/senate-bill/2346
- Warnock, R. (July 10, 2025). “Warnock, Scott Introduce Bipartisan Bill to Expand Hospital at Home Program.” Press release. https://www.warnock.senate.gov/newsroom/press-releases/warnock-scott-introduce-bipartisan-bill-to-expand-hospital-at-home-program/
- American Hospital Association (August 6, 2024, updated 2025). “Fact Sheet: Extending the Hospital-at-Home Program.” https://www.aha.org/fact-sheets/2024-08-06-fact-sheet-extending-hospital-home-program
- American Hospital Association (July 11, 2025). “Hospital at home extension bill introduced.” AHA News. https://www.aha.org/news/headline/2025-07-11-hospital-home-extension-bill-introduced
- Commonwealth Fund. “‘Hospital at Home’ Programs Improve Outcomes, Lower Costs But Face Resistance from Providers and Payers.” https://www.commonwealthfund.org/publications/newsletter-article/hospital-home-programs-improve-outcomes-lower-costs-face-resistance
- Better Care Playbook (April 2025). “Hospital at Home for Medicaid Enrollees: Evidence Roundup.” https://bettercareplaybook.org/_blog/2025/2/hospital-home-medicaid-enrollees-evidence-roundup
- American Medical Association (November 22, 2024). “Hospital at home saves lives and money: CMS report.” https://www.ama-assn.org/delivering-care/population-care/hospital-home-saves-lives-and-money-cms-report
- Centers for Medicare & Medicaid Services. Acute Hospital Care at Home approved provider lists and program evaluation reports (2024-2025)
- H.R. 1968 – Full-Year Continuing Appropriations and Extensions Act, 2025 (providing six-month extension through September 30, 2025)
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