Along with other hospitals in Florida and the U.S., Lee Health has grown a Hospital at Home program where patients receive acute inpatient-level care at home.

“I think this is the health care of the future,” said Kristy Dutton, Lee Health system director for Hospital at Home. “This is why we’re committing to this.”

Lee Health began the program for patients near its Gulf Coast Medical Center in 2024 and in May, expanded the service to Cape Coral Hospital. HealthPark Medical Center is set to start it later this year, followed by Lee Memorial Hospital next year, making it available through all four of the health system’s adult hospitals.

Yet uncertainty about how Lee Health and hundreds of other hospitals will receive payment from Medicare and Medicaid for acute at-home care threatens to derail the service for people covered by those plans.

Hospitals are required to receive a Congress-approved waiver from the Centers for Medicare & Medicaid, or CMS, to receive payment for at-home care. The federal government thus far has extended the plan only through Sept. 30, potentially sending at-home patients back to brick-and-mortar hospitals.

CMS will require hospitals with Acute Hospital Care at Home waivers to discharge patients or return them to the hospital Sept. 30 in the absence of congressional action to extend the initiative.

The Hospital at Home care initiative has grown widely since it was instituted during the COVID-19 pandemic to isolate the sick and free up beds. In the U.S., 142 health systems, representing 398 hospital facilities in 39 states, now have Hospital at Home waivers.

The idea is rooted in a 1990s pilot program led by geriatrician Dr. Bruce Leff at Johns Hopkins. The Mayo Clinic was the first Florida hospital to institute the program in 2020. It has grown to locations throughout the state. Lee Health has admitted 171 patients into their homes to date.

“The outcomes are really good with this,” Dutton said. “Patients are happier.”

In September, a CMS study commissioned by Congress verified that patients tend to benefit from fewer hospital-acquired infections and readmission rates equal or better than traditional hospitals.

Mary Mayhew

Florida Hospital Association asked Congress to extend the CMS waiver either permanently or for at least five years.

“The challenge we face right now is this lack of clarity about the long-term future of the program at the federal level,” said Mary Mayhew, CEO of the Florida Hospital Association. “It’s difficult for any organization to commit the financial resources to establish a program without significant assurances regarding the long-term federal commitment.”

Hospitals have not reported trouble with commercial insurance carriers paying for at-home care. But the CMS waiver that allows them to receive payment for seniors is crucial, Mayhew said.

Just before Thanksgiving, Fort Myers resident Wendy Markman was taken by ambulance to the hospital with pneumonia, Lee Health reported. She decided the idea of care at home sounded pretty good — her husband could be with her all the time along with, virtually, hospital staff.

“It was amazing that they could monitor my vitals and oxygen,” Markman said. “… The biggest thing was that I was able to get good sleep, which made a huge difference.”

Lee Health identifies patients who are suitable for at-home care. Physicians visit daily utilizing an iPad. A patch relays vital signs to nurses. Food is delivered by courier. A field nurse visits twice daily performing tasks, such as drawing blood or IV infusions.

Lee Health primarily accepts at-home patients who have pneumonia, chronic obstructive pulmonary disease, congestive heart failure, urinary tract infection or cellulitis. They can’t be critically ill. And they ideally live within 30 miles or less of their nearest hospital. Dutton said Lee Health is expanding those criteria when possible.

“If we can manage the care,” Dutton said, “we’ll take the patients.”