Patient use increased tenfold from 2020 to 2024; Medicare’s participation set to expire September 30, 2025, absent immediate Congressional action
BOSTON — The Massachusetts Health Policy Commission (HPC) releases new research, Hospital at Home in Massachusetts: Trends in an Emerging Clinical Model, describing how the hospital at home model of care has been implemented in Massachusetts. This model of care allows hospitals to provide hospital-level services in a patient’s home, rather than in a traditional “brick and mortar” setting for patients who are clinically stable enough to receive this care at home.
While some Massachusetts hospitals were early leaders in providing this model of care, hospital at home programs gained greater traction in 2020 when the Centers for Medicare & Medicaid Services (CMS) launched its program for Medicare beneficiaries amidst concern about hospital capacity during the most acute phase of the COVID-19 pandemic.
Although hospital at home programs represent a small share of total inpatient discharges in Massachusetts, these programs are growing rapidly, with 20 hospitals approved by CMS to participate, eight of which have active programs. From 2020 to 2024, hospital at home discharges in the Commonwealth rose nearly tenfold, reflecting both the entry of new hospital programs and existing programs increasing their capacity.
The HPC analyzed trends in hospital at home in Massachusetts from January 2020 to December 2024 using an innovative methodology to match hospital at home discharges to a comparison group of traditional inpatient discharges, based on the Center for Health Information and Analysis (CHIA) Hospital Inpatient Discharge Database. The HPC’s research explores the landscape of hospital at home in Massachusetts, including trends in volume, patient population, length of stay and hospital resource use, as well as comparing hospital at home to traditional inpatient care on these dimensions.
Two-thirds (66%) of hospital at home discharges were patients with Medicare coverage in Massachusetts in 2024. The program for Medicare beneficiaries launched in 2020 by the Centers for Medicare and Medicare Services is now set to expire September 30, 2025, unless Congress acts to extend Medicare’s participation. Given the upfront costs associated with operating a hospital at home program, certainty surrounding Medicare reimbursement for this model of care is critical for the sustainability of these programs.
“Hospital at home is a promising clinical model with benefits for patients who can receive acute care in the comfort of their home, and also potential benefits for the Massachusetts health care system overall,” said David Seltz, HPC Executive Director. “Given that nearly two-thirds of patients benefitting from hospital at home in Massachusetts are covered by Medicare, the expiration of Medicare’s authorization for these programs at the end of this month presents a pressing concern.”
Key Findings: Hospital at Home in Massachusetts
- Although hospital at home programs represent a small share of total inpatient discharges (0.6% in 2024), these programs are growing rapidly. From 2020 to 2024, hospital at home discharges in the Commonwealth rose nearly tenfold, from 461 discharges in 2020 to 4,523 discharges in 2024. This reflects both the entry of new hospital programs and existing programs increasing their capacity.
- In 2024, two-thirds (66%) of hospital at home discharges were patients with Medicare coverage, while commercial and Medicaid patients comprised 18% and 13% of hospital at home discharges, respectively. Medicare fee-for-service pays the same amount for hospital at home care as for traditional inpatient care. MassHealth also pays at parity between settings. Commercial payers may have other program requirements and may have different payment approaches.
- In contrast to national trends that found hospital at home patients were more likely to be White and less likely to have lower incomes, the demographics of hospital at home discharges in Massachusetts were similar to traditional inpatient discharges in terms of patient race/ethnicity, gender, and community income.
- Length of stay among hospital at home discharges was higher overall (by an average 1.7 days) than traditional inpatient stays. Longer average lengths of stay for hospital at home patients may reflect less urgency to discharge a patient to free the bed for another patient, as well as less patient urgency to return home and leave a hospital environment.
- HPC analysis of trends in hospital charges suggest that the nature of the services typically provided through hospital at home are changing over time, from mostly nursing and monitoring in 2020 to the addition of significant ancillary services by 2024, as programs were able to serve patients with more complex needs over time.
- Hospital at home patients were far less likely to be discharged to skilled nursing facilities (SNFs) compared to the matched inpatient comparison group (0.8% vs 11%) and far more likely to be discharged to home health (40% vs 25%). These differences may reflect that candidates for hospital at home may be lower acuity cases than their traditional inpatient counterparts and less likely to need SNF-level care. However, hospital at home may also offer advantages that reduce the need for SNF care, such as more time for recovery and potentially greater patient mobility.
Policy Implications
Recognizing the continued growth of hospital at home programs in Massachusetts, policymakers should consider monitoring:
- Appropriate admissions: To ensure that hospital at home is not used as a substitute for lower-cost, lower-intensity services such as home health care, program requirements should ensure that patients enrolling in a program require hospital-level care.
- Hospital capacity: The impact of these programs on hospital capacity should be monitored, including the potential to relieve hospitals from emergency department crowding and discharge delays, as well as potential spending impact from hospital bed expansion.
- Other important issues include:
- Continuing research on the benefit to patients, including care quality and patient and caregiver experience
- Determining appropriate payment rates
- Standardizing data collection
- Financial sustainability
The policy brief can be found on the HPC’s website. This research will be explored during the HPC Board meeting on Thursday, September 18, 2025.
