84% of US adults would participate in hospital-at-home programs

Most Americans said they would be willing to participate in hospital-at-home programs to return home sooner, according to a new survey.

The survey, conducted by remote patient monitoring (RPM) technology developer Vivalink, polled 1,025 United States adults over 40.

An overwhelming majority of US adults are likely to participate in a hospital-at-home monitoring program to get back home more quickly, with 39.15 percent saying they are very likely and 45.27 percent saying they are somewhat likely to participate in these programs. Only 15.58 percent said they are not likely to participate in a hospital-at-home program to return home sooner.

Most survey respondents (66.44 percent) had heard of hospital-at-home programs where patients are monitored remotely. Of those who had experienced hospital-at-home monitoring, 84 percent reported having a positive experience. Additionally, nearly half (49 percent) of respondents who had participated in a hospital-at-home program found the RPM devices easy to use. Of note, difficulty with device use was the primary concern among the 16 percent who said they were not likely to participate in hospital-at-home programs.

A little over 45 percent of survey respondents were monitored for heart-related conditions, 37.73 percent were monitored as part of cancer treatment or recovery services, 37.73 percent were monitored for neurological disorders, and 34.02 percent were monitored for diabetes, according to the survey.

The three primary reasons patients were willing to participate in at-home monitoring were the convenience and comfort of staying at home (46 percent), avoiding infection exposures in the hospital (23 percent), and confidence in RPM (18 percent).

The survey also shows that urban residents (71 percent) were more likely to have participated in hospital-at-home programs than rural residents (25 percent). However, urban respondents were less likely to prefer completely remote primary care compared to rural respondents, with only 19 percent of the former saying they preferred remote primary care compared to 36 percent of the latter.

Additionally, survey respondents over 70 were less likely to have heard of or participated in hospital-at-home programs than those in their 40s.

Respondents with three or more hospitalizations in the last 12 months were more willing to participate in hospital-at-home programs (95 percent) compared with respondents with two or fewer hospitalizations in the prior year (62 percent), the survey noted. A majority of those with three or more previous hospitalizations (95 percent) expressed greater trust in providers’ recommendations for hospital-at-home monitoring than those with two or fewer hospitalizations (78%).

Adoption of hospital-at-home programs has soared since November 2020, when the Centers for Medicare & Medicaid Services (CMS) launched the Acute Hospital Care at Home waiver. The waiver allows approved hospitals to provide hospital-level inpatient care in Medicare patients’ homes. As of May 13, 2024, 330 hospitals across 37 states had been approved for the waiver.

Research shows that these programs result in positive patient outcomes. A study published in January revealed that hospital-at-home programs are associated with low mortality, skilled nursing facility use, and readmission rates at one month following discharge.

For the study, researchers examined data for 5,132 Medicare patients receiving hospital-at-home care under the waiver between July 1, 2022, and June 30, 2023. The patient population was medically complex, with 42.5 percent having heart failure, 43.3 percent having chronic obstructive pulmonary disease, 22.1 percent having cancer, and 16.1 percent having dementia.

At 30 days post-discharge, the mortality rate was 3.2 percent, the rate of skilled nursing facility use was 2.6 percent, and the readmission rate was 15.6 percent.

The waiver is slated to expire on December 31, 2024, though stakeholders have called on Congress to extend the program for at least another five years. In March, more than 65 healthcare organizations signed a letter urging Congress to extend the waiver, citing the clinical benefits of hospital-at-home care and the significant increase in hospital-at-home programs in the last four years.

Congress appears to be seriously considering this extension request. Last month, the US House Ways and Means Committee advanced several new pieces of legislation, including one that would extend the Acute Hospital Care at Home waiver through 2029.