The Growing Impact of Government Funding on Hospital Care Models
At UMass Memorial Medical Center’s University Campus, hallways routinely flood with patients awaiting hospital rooms—a daily reality emblematic of the broader healthcare crunch. In response, the Worcester-based health system began its innovative home hospital care program four years ago as a strategy to manage this ongoing challenge.
However, on Saturday, UMass halted new admissions to its home hospital care program, prompted by the uncertainty surrounding congressional reauthorization. Currently, UMass provides care for around 20 patients daily in this setup, and the loss of these beds threatens to exacerbate overcrowding issues within its facilities.
“The term I would use is terror—we need to ensure we care for our community effectively,” voiced Constantinos Michaelidis, UMass’s medical director of the hospital-at-home initiative. “It’s about equipping our health system with the right tools, not stripping them away.”
UMass is among numerous hospitals granted a Medicare waiver to allow for inpatient care in a home setting, a program first established during the pandemic and extended multiple times since. However, the most recent extension, linked to a stop-gap funding bill enacted in March, is set to expire on September 30.
This month, the Centers for Medicare and Medicaid Services (CMS) warned hospitals that, unless Congress intervenes, any patients under Medicare-funded programs must be discharged or brought back to medical facilities by Tuesday midnight.
As the potential for a government shutdown looms and funding for the waiver diminishes, many hospital-at-home programs nationwide are already scaling back operations. For instance, New Jersey’s Hackensack Meridian Health ceased admitting new patients last Friday, and has since fully discharged its existing patient load. Similarly, ChristianaCare in Delaware stopped admitting Medicare patients over the weekend, although it continues to accept patients with other insurance plans, contingent on those providers’ policies. Mass General Brigham in Boston, operating one of the nation’s largest home hospital programs, has been steadily reducing its patient count, which dropped from 60 to 40 in just a few days.
While national statistics on home hospital capacity remain elusive, estimates suggest around 1,000 beds operate under this care model, according to David Levine, a physician at Mass General and a leader for national hospital-at-home initiatives.
Despite being a relatively new approach, experts emphasize that the loss of beds is particularly impactful where these initiatives exist, typically in heavily constrained capacity regions. As Arjun Venkatesh, an emergency medicine physician at Yale School of Medicine, noted, “Hospital-at-home beds aren’t widespread across America; they exist in specific locales that initially had urgent needs to address hospital congestion.”
Experts acknowledge that while hospital-at-home services are not a comprehensive solution to hospital crowding and its ramifications—often linked with declining patient outcomes—they provide a crucial means to alleviate pressure on emergency departments. For example, UMass Memorial has faced an average waiting list of 52 patients daily for hospital rooms throughout September.
“Our program was peaking; we were admitting more patients than ever,” reflected Michaelidis on the progress UMass was making. “Now, it’s frustrating and disheartening, particularly when we are achieving such success for our community, only to be forced to pause our efforts.”
Hospital leaders are expressing hesitancy in expanding or initiating new initiatives due to fears surrounding the temporary nature of the Medicare waiver. With previous shutdown threats jeopardizing programs over the last year, there is a glimmer of hope with a bipartisan bill under consideration that aims to extend the program for an additional five years.
“Linking the waiver extension to budget resolutions poses a continuous risk, inhibiting hospital investment in sustainable care models,” stated Lee Fleisher, CEO of Rubrum Advising and former chief medical officer at CMS. “A permanent waiver extension is essential for shaping a robust final program.”
Patients engaged in both UMass and Mass General’s home hospital program generally experience an average stay of just over four days at home. Notably, about one-third of UMass patients transition directly from the emergency department to home care, receiving comprehensive services such as nursing care and lab tests, much like those afforded in hospital settings. This transition proves beneficial not just for patient care but also for freeing up space in hospital facilities for critical cases.
Stephen Dorner, who manages the clinical operations of the hospital-at-home program at Mass General, indicated opportunities may arise to either discharge patients for outpatient care or limit the spectrum of services provided. However, he acknowledged that such measures would still constrain operations significantly.
Taking lessons from December’s impending end of the temporary waiver extension, Dorner has been strategizing to mitigate disruption, albeit the reality remains sobering. “For better or worse, we’ve had ample preparation time, but it doesn’t lessen the anticipated challenges ahead,” he concluded.
