Is the Hospital at Home strategy going too far too fast?

Key takeaways

Mass General Brigham is narrowing its Home Hospital program to emergency department patients at Mass General Hospital and Brigham and Women’s Hospital after losses of about $30 million a year, and Cone Health, Health First and Covenant Health have ended their programs. The cutbacks show that Medicare’s waiver extension through 2030 has not solved problems with patient volume, payer coverage and cost. Tampa General Hospital’s Peter Chang said programs should expect to refine their service areas, patient criteria and staffing as the model matures.

As Hospital at Home/Care at Home programs establish a foothold in health systems across the country, some are finding that growth can be difficult, especially for hospitals in smaller and rural communities.

Recent news that Mass General Brigham is scaling back its program offers evidence that expanding won’t be easy. A strategy that began as a means of helping crowded hospitals reduce their patient census doesn’t work so well when the focus shifts to smaller, more diverse populations.

And MGB isn’t the only health system cutting back:

• Cone Health in Greensboro, N.C., announced in October that it was “sunsetting” its program, which was launched in April 2025 and had served as many as six patients at a time. The health system had noted that most insurers were not covering the service.
• Health First in Rockledge, Fla., announced in September that it was ending its program, which was launched in 2021 during the height of the COVID pandemic, as part of a district-wide rollback, which includes 214 layoffs. The four-hospital health system had served as many as 1,000 patients in 2024, when leadership said it was poised for rapid growth.
• Covenant Health in Knoxville, Tenn., announced in June that it was discontinuing its program, which was launched in March 2023, at four Tennessee hospitals, citing low patient volume, uncertain federal funding and other organizational priorities.

For MGB, one of the earliest and more aggressive supporters of the Acute Care at Home model, expanding the program to other communities and patient populations may have exposed a significant challenge. The farther away you go from the core strategy, the more difficult it is to maintain the volume necessary to support what is still a hefty budget.

MGB officials have cited sustained losses of about $30 million a year over the past three years as the root cause of the rollback of a program that they’ve been running since 2017.

In its announcement, leadership said the health system would, beginning on November 10, refocus the program on patients transitioning home from the emergency departments at Mass General Hospital and Brigham and Women’s Hospital, while services at three other hospitals would be “paused indefinitely.”

In a letter to staff, Heather O’Sullivan, MSN, APRN, FAAN, President and CEO of the MGB Healthcare at Home program, said the program’s focus has shifted through the years to the outlying community hospitals, while not solving ongoing capacity constraints at its two primary hospitals. That, combined with the annual losses, meant the program wasn’t operating in a sustainable manner.

“Home Hospital remains an important part of our care delivery strategy,” O’Sullivan wrote. “However, as Mass General Brigham continues to face significant operational and financial challenges across our system, we must ensure our resources are aligned with the areas of greatest need and impact.”

The upshot is that even though Medicare reimbursement for the CMS-supported Acute Hospital Care at Home program is ensured through 2030 with a waiver extension, health systems and hospitals are still struggling to make ends meet, even as they’re proving that the model improves clinical outcomes.

So MGB is, in essence, shifting the program back to its roots.

“This focus will allow us to more effectively serve those patients, help relieve crowding in our emergency departments and support the program’s long-term sustainability,” MGB said in a news release. “Home Hospital leadership has been working to update both the care models and supervisory and administrative roles and will continue to identify opportunities to operate more efficiently, including fully utilizing available clinical capacity and achieving improvements in length of stay. We will continue to evolve and refine the model with an unwavering commitment to quality, safety and an exceptional patient experience.”

Peter Chang, Senior Vice President and Chief Transformation Officer at Tampa General Hospital and a participant in CHIME’s recent Hospital at Home Virtual Summit, said MGB isn’t an example of a bad strategy, but a signal that healthcare organizations need to plan out their Care at Home growth with an understanding that what works in one place with one group of patients won’t necessarily work in other places with different patients.

“Hospital at Home is moving from an early phase of rapid adoption into a more mature phase that requires health systems to prove the model clinically, operationally and financially,” he said. “The federal waiver extension through 2030 provides greater regulatory stability, but sustainability still depends on consistent patient volume, payer participation, efficient logistics, strong clinical integration and the ability to operate at scale.”

“I would expect programs to continue evolving,” he added. “Some organizations may refine their service area, patient criteria, staffing model or growth pace as they learn what works in their market. That is not necessarily a retreat from the model. It can be part of building a more durable program. The broader signal remains encouraging: the federal pathway has been extended through 2030, and health systems continue to participate. The question is less whether Hospital at Home has a future and more how each organization designs a model that is clinically sound, operationally reliable and financially sustainable.”

The challenges reflect what critics have long said about the Hospital at Home strategy, that providing acute care services at home is complex and costly. When a program is scaled out to different locations and populations, the variables change, and the formula has to change with them. How leadership responds to these changes and revises its strategy may well determine whether a Care at Home model will succeed.

“The strongest programs will become more integrated with the health system’s core operations,” Chang said. “That means identifying appropriate patients earlier in the emergency department and inpatient units, expanding payer participation, standardizing clinical and escalation protocols, strengthening home-based logistics and using technology to support, not replace, the care team. Programs also need to measure the outcomes that matter: safety, readmissions, patient experience, capacity created and total cost of care.”

Eric Wicklund is a veteran of more than two decades in the healthcare innovation and technology space, spending time as a writer, editor, project leader and moderator with MedTech Media, HIMSS Media, xTelligent Media and HealthLeaders.