Can Hospital at Home Deliver Comparable Outcomes to Traditional Inpatient Care for Medicare Patients?

Hospital-at-home (HaH) care was associated with lower in-hospital mortality and reduced emergency department use within 30 days of discharge compared with traditional inpatient hospitalization among Medicare beneficiaries, according to a new propensity score–matched study published in JAMA Network Open.¹

The findings arrive as health systems continue to grapple with rising inpatient demand, workforce shortages, and constrained bed capacity. Nationally, alternative care models such as HaH have gained traction as a potential way to expand capacity while maintaining quality. CMS formally accelerated adoption during the COVID-19 pandemic through the Acute Hospital Care at Home initiative, which enabled hospitals to bill for inpatient-level services delivered in patients’ homes.²

Broader evidence suggests growing interest in home-based acute care models as health systems look for scalable solutions. A 2023 Commonwealth Fund analysis noted that hospital-at-home programs can reduce costs and complications while maintaining equivalent outcomes, though implementation remains uneven across regions and health systems due to reluctance of payers to reimburse for this care and concerns about patient safety.³

In the current study, researchers analyzed 15,871 Medicare fee-for-service beneficiaries aged 65 and older who were treated between January 2021 and December 2022 at 68 eligible U.S. hospitals. The propensity score-matched cohort included 4174 HaH admissions and 11,697 traditional inpatient admissions.

How Does Hospital at Home Affect Mortality, Readmissions, and Emergency Department Use?

Clinical results showed statistically significant differences in the matched cohort favoring HaH for several endpoints. In-hospital mortality occurred in 0.4% of HaH admissions compared with 3.6% of inpatient admissions (adjusted odds ratio [aOR], 0.09; 95% CI, 0.06–0.16). Emergency department use within 30 days of discharge was also lower in the HaH group (8.8% vs 10.0%; aOR, 0.86; 95% CI, 0.76–0.97). There was no statistically significant difference in 30-day readmissions between groups (11.7% vs 11.0%; aOR, 1.07; 95% CI, 0.96–1.20).

Secondary outcomes suggested additional benefits for HaH. Intensive care unit escalation was lower (3.5% vs 7.9%; aOR, 0.39), and hospital-associated complications were reduced (3.6% vs 5.1%; aOR, 0.59). However, index length of stay was slightly longer in the HaH group (aPC, 1.23%), and index hospitalization costs were modestly higher (aPC, 1.10%), although post-discharge costs were lower (aPC, 0.65%), resulting in slightly lower total episode spending.

What Do These Findings Mean for Scaling Hospital at Home Across US Health Systems?

The findings align with prior randomized and observational studies suggesting that hospital-at-home models can achieve comparable clinical outcomes to inpatient care while potentially reducing downstream utilization. Prior randomized trials, including this one, have similarly demonstrated noninferior outcomes and reduced institutional complications with lower costs when using home-based acute care pathways.⁴

In this study, the authors emphasize that HaH outcomes likely reflect early implementation patterns, where hospitals selectively enrolled clinically appropriate patients and concentrated services within higher-volume centers. Notably, 11 hospitals accounted for roughly half of all HaH admissions, underscoring uneven national adoption.¹

The study is limited by its observational design and reliance on Medicare fee-for-service claims data, which lead to an inability to fully account for unmeasured psychological severity, functional status, caregiver support, and home environment—all of which may influence eligibility for HaH. Additionally, the analysis reflects early implementation under the CMS waiver, a period shaped by pandemic-era operational pressures and evolving program maturity when it came to patient selection, outcomes, and implementation.

Taken together, the findings suggest that hospital-at-home may offer a viable alternative to traditional inpatient care for appropriately selected Medicare patients, with comparable or improved short-term outcomes. However, the authors emphasize that broader adoption will require sustained investment in workforce capacity, standardized implementation frameworks, and policy mechanisms that ensure equitable access across urban and rural settings.

As health systems continue to test new models of care delivery, the challenge moving forward will not only be demonstrating clinical effectiveness but also scaling infrastructure capable of supporting safe and equitable hospital-level care beyond hospital walls.

References

1. Vakkalanka JP, Young TL, Bianchi G, et al. Outcomes associated with hospital at home vs traditional inpatient stay. JAMA Netw Open. 2026;9(5):e2610810. doi:10.1001/jamanetworkopen.2026.10810

2. Fact sheet: Report on the study of the Acute Hospital Care at Home initiative. CMS.gov. September 30, 2024. Accessed May 5, 2026. https://www.cms.gov/newsroom/fact-sheets/fact-sheet-report-study-acute-hospital-care-home-initiative

3. Klein S. “hospital at home” programs improve outcomes, lower costs but face resistance from providers and payers. The Commonwealth Fund. Accessed May 5, 2026. https://www.commonwealthfund.org/publications/newsletter-article/hospital-home-programs-improve-outcomes-lower-costs-face-resistance

4. Shepperd S, Doll H, Angus RM, et al. Avoiding hospital admission through provision of hospital care at home: a systematic review and meta-analysis of individual patient data. CMAJ. 2009;180(2):175-182. doi:10.1503/cmaj.081491