Atrium Health is seeing early success with the nation’s first pediatric hospital-at-home program, but it could take longer for other health systems to follow its lead.
Charlotte, North Carolina-based Atrium — part of Charlotte, North Carolina-based Advocate Health — launched the program at Levine Children’s Hospital the first week of February and has provided acute-level care at home to approximately 20 children so far, according to Dr. Stefanie Reed, medical director at Atrium Pediatric Hospital at Home. While some other children’s hospitals have expressed interest in starting acute care-at-home programs, challenges around reimbursement, technology, staffing and patient acceptance have prompted them to take a wait-and-see approach.
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But Reed said home-based acute care has proven to be such a hit with Levine's patients and their families that the hospital could quickly double admissions to around a dozen patients a day from five or six.
“We operate at or above capacity well over 95% of the time. We are looking at this as a way to increase our ability to reach patients,” Reed said. “Our families are saying this is how they want to receive care.”
Levine’s pediatric hospital-at-home program cares for patients under 18 years old who qualify for hospitalization, but can receive care where they live. Patients get daily in-person paramedic visits, telehealth visits with physicians and are monitored remotely. Reed said the program is similar to one Atrium Health’s Carolinas Medical Center in Charlotte has offered for the past five years to adult patients. The two programs operate separately, but share a command center and some administrative functions.
Reed said Atrium Health hopes its hospital-at-home program will reduce patient readmissions at Levine Children’s Hospital — something that could encourage other children’s hospitals to launch similar programs.
“We see this as an important part of the care model and an innovative mode for the future,” Reed said.
Home-based acute care took off during the COVID-19 pandemic. More than 400 hospitals across 39 states have received Medicare waivers that allow them to care for certain patients in their homes at the same reimbursement rate as those getting care in a facility. But the trend has been slow to spread to children’s hospitals.
Reimbursement is part of the problem. Many private insurers and state Medicaid programs don’t cover home-based acute care. North Carolina is one of about a dozen states that do, paving the way for Levine to offer the program.
Atrium did not provide a breakdown of the payer mix for the pediatric hospital-at-home program.
Reimbursement is just one hurdle in launching and scaling pediatric hospital-at-home programs, according to Dr. Stephen Dornar, chief clinical and innovation officer for Mass General Brigham’s Healthcare at Home program.
The Boston-based health system offers acute care-at-home programs across five hospitals through the Medicare waiver. However, it does not yet offer a similar program at Mass General Brigham’s Children’s Hospital, even though Massachusetts' Medicaid program pays for acute care-at-home.
Dorner said there are different considerations to weigh before offering home-based hospital care to children.
“Children have distinct medical needs and will require clinical protocols, equipment, technology, staffing, and so much more to be tailored to the pediatric population’s needs,” Dorner said in an email.
Nemours Children’s Health laid out plans in late 2023 to offer home-based hospital services to young patients near Orlando, Florida, and Wilmington, Delaware, with certain respiratory illnesses. But the Jacksonville, Florida-based nonprofit health system has not yet launched the program and a spokesperson did not provide a timeline when asked.
