South Jersey ‘hospital at home’ programs are restarting post-government shutdown, but face an uncertain future

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When patients come into the emergency room at a Virtua Health hospital in South Jersey, they might get a choice: stay in the hospital for a couple nights for treatment or get that same treatment from the comfort of their own home.

It’s part of a Medicare waiver program called Acute Hospital Care at Home, which allows doctors and nurses to remotely monitor and perform in-person exams, blood draws, intravenous medications and X-rays for eligible, stabilized patients outside the walls of a health facility.

“It truly is an acute care program that brings all the resources of the hospital room that you traditionally imagine right into your own living room,” said Dr. Diego Ortega, the clinical lead physician of Virtua’s Hospital at Home program.

Virtua Health and other systems across the U.S. that suspended their hospital-at-home programs during the recent government shutdown have since resumed enrolling new patients.

But they now face a new challenge, as the program is set to expire at the end of January. Health care providers and trade organizations are urging Congress to either make the program permanent or extend it for at least another five years.

“There is a huge potential for this kind of care model to grow and expand over the years,” said Dr. Rupa Kashyap, chief hospitalist at Virtua Willingboro Hospital. “Any kind of permanence would definitely help implement this in a bigger way and improve outcomes for everybody.”

Flexibility for both hospitals and patients

The federal Acute Hospital Care at Home initiative was originally launched in 2020 during the COVID-19 pandemic to offer hospitals some flexibility and help free up inpatient beds for the sickest patients.

Since then, about 147 health systems with over 400 facilities and departments nationwide have been approved to participate, according to the Centers for Medicare and Medicaid Services.

Good candidates for the program include people with COVID-19, pneumonia, skin infections, issues related to congestive heart failure, urinary tract infections and other conditions that can be stabilized and managed, Ortega said.

At Virtua Health, enrolled patients are monitored 24/7 with devices that record their vital signs. Data is then transmitted in real time to Virtua’s command center in Pennsauken, which is staffed by nurses and other health providers.

In some ways, Ortega said providers can learn even more about their patients at home compared to those staying in the hospital.

“We can see when a patient of ours is improving day by day, because we have this flow of continuous vitals from this technology,” he said. “So, I can tell now that, say, Mrs. Smith is no longer short of breath when she’s been walking around in her own home.”

People receiving care at home also receive at least two daily in-person visits from registered nurses who can draw blood, administer intravenous medications and perform electrocardiograms and X-rays. Patients see a doctor at least once a day, either in person or remotely through telehealth.

The program has had some early success. A 2024 federal report found that patients treated at home had overall lower mortality rates compared to their counterparts treated at the hospital.

The study also found that hospital-acquired infections were lower among patients in hospital-at-home programs, including the one at Virtua Health.

“Whether they have less hospital acquired infections, they have less falls, they have less episodes of confusion, which a lot of elderly folks get in the hospital, all that is much less when they are cared for at home,” Kashyap said.

Uncertain future for hospital care at home

When Virtua initially launched its program in early 2022, Ortega said services were mostly restricted to those with Medicare health insurance. But since then, the health system has partnered with other private insurers in New Jersey that now reimburse for this type of care delivery.

Interest in the program has grown over the years, Ortega said, as more patients and families learn about the potential benefits of receiving treatment at home, including eliminating barriers such as transportation issues.

“There’s so many crucial learnings and insights that we gain in this type of approach of medicine where we are now placing ourselves at a person’s kitchen table versus the other way around,” he said.

However, the program’s future remains uncertain.

Congress has extended the Medicare waiver several times, but it lapsed when the government shut down on Oct. 1. With a deal to reopen the government, the hospital program now has a new expiration date of Jan. 30.

If Congress does not extend it again or permanently adopt the federal initiative, health systems will need to either discharge their patients or bring them back into the hospital for care.

It’s unfortunate timing, Kashyap said, as hospitals are about to enter a busy season of respiratory illnesses and disease.

“Every winter, we see surges in the hospital. We see the ERs getting full. We have a backlog of patients waiting to be admitted,” she said. “Whether it’s the flu, pneumonia, in the holiday season, we have patients coming in right afterwards, there’s always that influx.”