Becker’s Healthcare Podcast

Episode Title: "The Uncertain Future of Hospital at Home Programs with Molly Gamble"

Air Date: September 30, 2025

Episode Overview

In this episode, Becker's Healthcare Vice President of Editorial, Molly Gamble, delves into the uncertainty surrounding the future of CMS’s Hospital at Home waiver, especially as its expiration looms during a time of federal funding uncertainty. Gamble explores both the historical context and the current anxiety felt by health system leaders over the sustainability and financial viability of hospital-at-home care models.

Key Discussion Points & Insights

1. Looming Expiration of the CMS Hospital at Home Waiver

• Urgency Around the Waiver (00:54–02:17):
  Molly Gamble highlights the intense worry among hospital leaders over the pending expiration of the federal Hospital at Home waiver by CMS. With Congress yet to act, hundreds of programs face crucial decisions about continuity (“...urgency here is that unless Congress acts before September 30, hundreds of hospitals will have to face some tough decisions about their programs...” — Molly Gamble, 01:21).
• The policy dilemma is not just a bureaucratic headache, but one that “feels like watching the future of healthcare hang by a thread” (Molly Gamble, 01:41).

2. Hospital at Home: A Brief History

• Origins and Growth (02:19–03:23):
  Hospital at home is not a new concept; it traces its origins back to the mid-1990s with Dr. Bruce Luff at Johns Hopkins, but it long struggled due to lack of Medicare reimbursement.
• The pandemic catalyzed its growth as CMS, using emergency powers, waived several conditions of participation in 2020, allowing hospitals to launch the Acute Hospital Care at Home program and unlocking reimbursement (~03:00).

3. National Adoption and Scale

• Stats and Spread (03:29–03:46):
  As of July 2025:
  • 400 hospitals across 142 health systems in 39 states have been approved to offer hospital-at-home care.
  • Despite national reach, programs are small, generally ranging from a dozen to 50 patients each.
• Funding Extensions (03:48–04:30):
  Congressional extensions have become increasingly short and last-minute (two years, then 90 days, then six months).
  • “There’s a lot of anxiety around... pins and needles, as some have described every extension. They feel as though they are holding on until the very last minute...” (Molly Gamble, 04:13)

4. Investments and Reluctance

• Financial Risk and Strategy (04:33–05:20):
  Some health systems have invested millions into the hospital-at-home model—acquiring equipment, setting up new staffing models, and implementing technology to support connectivity in patients’ homes.
  • However, another group of health systems remain reluctant, “not going to make that bet” until there is more assurance of long-term federal backing, resulting in a “wait and see” approach.

5. Implications if the Waiver Expires

• Potential Patient Relocation (05:21–05:49):
  Without an extension, patients currently receiving care at home may need to be moved back into hospitals—a reversal of the recent healthcare trend toward further decentralization:
  • “...the exact opposite of what we've talked about so long in healthcare, where we’re moving patients out of the hospital into the home. So this could be a really unusual situation where the very opposite occurs.” (Molly Gamble, 05:44).

6. The Bigger Picture: Future of Home-Based Care

• Fit within Care Delivery Transformation (05:50–06:35):
  Hospital at home was seen as a major step in migrating patient care out of high-acuity settings.

  • Leaders express confusion and frustration at the piecemeal approach to program extensions.
  • Programs show potential to reduce readmissions and improve outcomes, but financial ROI is still “under review.”
  • A five-year extension bill is pending, requiring a comprehensive cost-effectiveness study.

• Uncertain Trajectory (06:36–07:27):

  • “...what does this mean for any sort of care delivery that moves... into the home... this could be a pretty serious signal that it might be a slower walk to that happening than I think it might have seemed at the time.” (Molly Gamble, 07:14).

Notable Quotes & Memorable Moments

• "This isn’t just a policy headache … it also just feels like watching the future of healthcare kind of hang by a thread."
  — Molly Gamble (01:41)

• “You have some that have made some serious investments in getting these programs off the ground. You have a whole other group... that until there’s more assurance from CMS and Medicare funding... are likely not going to make the investments and expenditures...”
  — Molly Gamble (04:47)

• “There will be patients moving from the home to the hospital, which is the exact opposite of what we've talked about so long in healthcare, where we’re moving patients out of the hospital into the home.” — Molly Gamble (05:44)

• “This could be a pretty serious signal that it might be a slower walk to [home-based care] happening than I think it might have seemed at the time.”
  — Molly Gamble (07:14)

Timestamps for Key Segments

• 00:54–02:17 — Introduction of the waiver’s looming expiration and its significance
• 02:19–03:23 — Historical context of hospital at home
• 03:29–03:46 — Current spread and statistics
• 03:48–04:30 — Growing anxiety and shortened extension periods
• 04:33–05:20 — Investment dynamics and health system strategies
• 05:21–05:49 — Implications of waiver expiration for patients
• 05:50–07:27 — Mixed results, future prospects, mention of proposed legislation

Summary

This episode offers a concise yet thorough examination of the precarious position of hospital-at-home programs as federal support hangs in the balance. Molly Gamble offers a reporter’s clarity combined with industry insight, framing the potential loss of the CMS waiver as both a setback for individual hospitals and a significant barometer for the pace of care-delivery innovation. Listeners come away with an understanding of both the promise and the challenges of moving acute healthcare into the home—and the significant policy and financial uncertainties that will shape that future.