In a national study of 15,871 matched Medicare admissions, hospital-at-home patients made fewer emergency department visits within 30 days of discharge (8.8% versus 10.0%) and had lower in-hospital mortality, with no increase in readmissions. The signal is encouraging, though who is treated this way, and where, matters as much as the headline.
Hospital-at-home patients made fewer emergency department visits within 30 days of discharge than patients treated in a traditional inpatient ward, 8.8% versus 10.0%, according to a 2026 analysis of Medicare beneficiaries in JAMA Network Open. They also had lower in-hospital mortality and were no more likely to be readmitted.
Hospital at home is acute, hospital-level care delivered in a patient’s residence instead of a ward. Selected patients who would otherwise be admitted receive nurse and physician visits, intravenous medications, remote monitoring, and point-of-care testing at home. The model has grown under Medicare’s Acute Hospital Care at Home waiver, and the open question has been whether care moved out of the building is as safe as care inside it.
What the study found
The analysis compared hospital-at-home admissions with traditional inpatient stays among fee-for-service Medicare beneficiaries aged 65 and older, using propensity-score matching to pair similar patients. Across 15,871 matched admissions, home patients had:
- Lower emergency department use within 30 days of discharge: 8.8% versus 10.0%.
- Lower in-hospital mortality: 0.4% versus 3.6%.
- No significant difference in 30-day readmissions: 11.7% versus 11.0%.
The mortality figures deserve a careful reading. This is an observational study, and much of the difference likely reflects who is selected for home care. Patients stable enough to be sent home are, on average, less sick than those kept on a ward, and matching narrows that gap but does not close it. The mortality result is best read as reassuring about safety, not as evidence that home care itself saves lives. The steadier finding is the direction: on the outcomes value-based care weighs most, hospital at home matched or beat inpatient care while sending fewer patients back to the emergency department.
Earlier trials point the same way
The result is not isolated. A U.S. randomized controlled trial of substitutive home hospitalization found home patients used fewer laboratory and imaging tests, were more physically active, and were readmitted less often within 30 days, 7% versus 23%, at 38% lower direct cost. A systematic review and meta-analysis of nine randomized trials found that for chronically ill patients arriving at the emergency department, hospital-at-home care carried a lower risk of readmission and long-term care admission, with no increase in mortality. The new Medicare study extends that trial evidence to a large, real-world population served by everyday programs.
Why it matters for value-based care
Reducing avoidable emergency department visits is close to a defining goal of value-based care, and not only because it saves money. A return trip to the emergency department after a hospitalization often signals that something went wrong: a symptom unresolved, a medication not reconciled, a handoff that did not hold. Fewer post-discharge visits, with no rise in readmissions, is a plausible sign of a smoother transition home. It also frees scarce inpatient and emergency capacity in a system short on beds and staff.
For risk-bearing organizations, the economics run the same way. When a provider or plan is accountable for the total cost of a patient’s care, an acute episode handled safely at home and followed by fewer downstream emergency visits is the pattern a well-designed model should reward.
The caveats
Two cautions temper the result. First, hospital at home is concentrated: in the Medicare study, a small number of hospitals accounted for roughly half of all home admissions, and the highest-volume programs were overwhelmingly urban. A model that reaches only a narrow, urban slice of the country does little for rural and underserved populations. Second, these results describe carefully selected patients, not everyone who arrives at the hospital. The open question is no longer whether hospital at home can work, but which patients benefit, how to extend it equitably, and how to pay for it in a way that sustains quality rather than shifting volume.
Sources
- Vakkalanka JP, Young TL, Bianchi G, et al. Outcomes Associated With Hospital at Home vs Traditional Inpatient Stay. JAMA Network Open. 2026;9(5):e2610810. doi:10.1001/jamanetworkopen.2026.10810 (opens in a new tab)
- Levine DM, Ouchi K, Blanchfield B, et al. Hospital-Level Care at Home for Acutely Ill Adults: A Randomized Controlled Trial. Annals of Internal Medicine. 2020;172(2):77-85. doi:10.7326/M19-0600 (opens in a new tab)
- Arsenault-Lapierre G, Henein M, Gaid D, et al. Hospital-at-Home Interventions vs In-Hospital Stay for Patients With Chronic Disease Who Present to the Emergency Department: A Systematic Review and Meta-analysis. JAMA Network Open. 2021;4(6):e2111568. doi:10.1001/jamanetworkopen.2021.11568 (opens in a new tab)