Mass General Brigham (MGB) ran the largest hospital-at-home program in the country. As recently as 2025, it planned to grow to 250 beds. This fall, facing an average annual loss of about $30 million, it capped the program at 30 patients, down from 70, and paused it at three of its five hospitals. What remains is concentrated at Mass General and the Brigham where inpatient beds are tightest.
Smaller systems have gone further. Cone Health in Greensboro, N.C., is winding down its program this quarter after a year in which it never served more than six patients at a time, largely because most insurers would not cover it. Health First in Florida ended its program in September as part of broader workforce cuts, and Covenant Health in Tennessee shut down its program in April without publicly noting a reason.
A Three-way Mismatch
In Vantage Clinical Partners' view, these retreats share a root cause. Hospital at home pays off only when three things line up: clinician resources, patient volume, and a diagnosis mix that frees real bed-days.
MGB's resources ran ahead of its volume. It built for growth across five hospitals and lost money doing it, so pulling back to its two most crowded hospitals reads as right-sizing rather than surrender. Cone had the opposite problem. A home program carries a fixed team, round-the-clock coverage and logistics whether it serves six patients or sixty, and Cone did not get past six.
Neither case is unusual. Only 68 waivered hospitals had 12 or more home admissions in 2021–2022, and 11 of them accounted for about half of all admissions. The waiver requirements make programs costly and risky to build, especially for small and rural hospitals, and Medicare-only coverage shrinks the eligible pool further.
Even with enough volume, diagnosis mix decides whether physical beds open. A program frees capacity only when it takes patients who would otherwise hold a bed. The wrong mix fills the program without relieving in hospital care. Cone, Health First and Covenant didn't disclose their volume or case mix, so reading their exits through this lens is our interpretation.
Quality is Not the Problem
None of this is particularly about outcomes. In a matched study of 15,871 Medicare beneficiaries, hospital-at-home patients had lower in-hospital mortality and fewer emergency visits in the 30 days after discharge, with no difference in readmissions. A Cochrane review of 20 trials reached a consistent conclusion: little or no difference in mortality, a better chance of still living at home six months later, and probably lower costs. The model also eases the post-acute pipeline. In Massachusetts, fewer than 1% of home hospital patients went on to a skilled nursing facility, compared with 11% of traditional inpatients.
Programs built for fit can scale quickly. Penn Medicine launched in April 2026 at two hospitals, accepting only a limited set of conditions. It enrolled its 100th patient within five months and freed an estimated 483 inpatient bed-days. And with the Medicare waiver now secured through 2030, policy uncertainty is no longer a credible excuse. Leaders of the Hospital at Home Users Group have called the extension a window to scale.
Design Carefully
The lesson is to design backward from the bed. Sustainable programs start where beds are scarcest, at hospitals with high occupancy and chronic ED boarding, where every freed bed carries real value. They select diagnoses for bed-day impact, favoring multi-day, predictable stays such as heart failure, COPD, pneumonia, cellulitis and urinary tract infections. They staff to actual census rather than projected growth, using flexible models such as shared hospitalist coverage and a virtual command center. They reach a volume threshold that covers fixed costs at one site before adding the next. And they broaden payer coverage beyond traditional Medicare, bringing in commercial, Medicare Advantage and Medicaid plans so volume has room to grow.
The next year will show whether the field consolidates or regroups. We are watching whether other systems under cost pressure follow MGB in shrinking programs to their most crowded hospitals, whether commercial and Medicare Advantage plans begin covering hospital at home in earnest, what the federal efficacy study Congress required alongside the 2030 extension finds, and whether programs consolidate around operators large enough to spread fixed costs across more patients.
Beth Papetti, MBA FHM
Principal & Chief Operating Officer
References
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Massachusetts home hospital programs face another shutdown. (2026, January 29). The Boston Globe. https://www.bostonglobe.com/2026/01/29/business/massachusetts-home-hospital-shutdown/
MGB is cutting a popular home care program in half, and more details on the hospital system's layoffs. (2026, October 23). The Boston Globe. https://www.bostonglobe.com/2026/10/23/business/mass-general-brigham-layoffs/
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