Cone Health, the Greensboro, North Carolina, health system, is ending its hospital-at-home program after reviewing its priorities and the model’s long-term sustainability, Becker’s Hospital Review reported on Oct. 14. The program, which treated hospital-level patients in their own homes, will wind down during the fourth quarter, and current patients will continue to receive care during the transition.
The decision stands out because Medicare’s payment pathway for these programs is no longer on a short leash. Congress extended the federal waiver through 2030 earlier this year. For patients and families, Cone’s exit raises a practical question: if a program that reported no patient deaths or care-associated infections in its first year can close, how dependable is this kind of care?
A Small Program with Strong Early Results
Cone launched hospital at home in April 2025. In a June 1 release in its first year, the system reported no patient deaths and no health care-associated infections. The program was capped at six patients at a time, and Cone had planned to expand once more insurers began covering the model.
In its statement, Cone said health systems nationwide are reassessing these programs amid shifting reimbursement, operational complexity, and questions about long-term viability. «We are proud of the care provided through the program and grateful for the team members who made it possible,» the system said. Cone added that it will redeploy staff and maintain continuity of care for the small number of patients currently enrolled.
The Waiver Behind Hospital at Home
Hospital at home programs let certain patients with conditions such as heart failure, pneumonia or infections receive hospital-level care at home, including daily clinician visits, remote monitoring and rapid response if their condition worsens. Medicare pays for it through the Acute Hospital Care at Home waiver, first created during the COVID-19 pandemic and renewed several times since.
The waiver’s history has been rocky, which has made long-term planning difficult. When it lapsed during the federal government shutdown, health systems had to discharge or transfer Medicare patients by midnight Oct. 1, 2025. Mayo Clinic moved about 30 home patients, and a Mayo leader said its Florida hospital was already at 110% capacity, Becker’s reported at the time.
Congress then extended the waiver through Sept. 30, 2030, in the Consolidated Appropriations Act, 2026, signed Feb. 3, according to a New Jersey Department of Health memo. As of March, 366 programs across 139 health systems in 37 states had been approved, according to the American Medical Association.
Stability on Paper, Strain in Practice
A five-year runway helps, but it does not fix every challenge. The waiver is still temporary, and permanent Medicare coverage is not guaranteed, according to a Digital Health Insights tracker of the field. Many commercial insurers do not pay for hospital at home on the same terms, which can leave programs with too few eligible patients to cover staffing, technology, and round-the-clock response.
Programs also carry costs that ordinary hospital units can spread more easily. They need clinicians who can travel to homes at any hour, delivery of medications and lab samples, monitoring technology, and a command center staffed around the clock. A program capped at a handful of patients may carry those costs without enough admissions to offset them.
Leaders have described the toll of uncertainty. Dr. Michael Nassif, medical director of Saint Luke’s Hospital In Your Home in Kansas City, told Becker’s last year that uncertainty is hard on administrators, especially when programs employ several full-time staff members.
The trend is not one-directional. NewYork-Presbyterian launched a program in Manhattan in November 2025, Penn Medicine is rolling one out across three hospitals, and Cleveland Clinic has admitted about 3,000 patients since 2023 and is expanding into Florida. Tampa General Hospital says early data suggest lower readmission rates for its program, though it has not released figures.
Patients Who Lose the Home Option
Patients who prefer recovering at home lose an option when a program closes. That group often includes older adults, people with mobility limits, and caregivers who find hospital visits difficult. For them, a closure may mean a traditional hospital admission, possibly with longer emergency department waits when beds are full.
Patients enrolled in a program that is winding down can ask their care team how follow-up visits, prescriptions, and equipment returns will be handled, and whom to call after hours. Anyone being considered for hospital at home elsewhere can ask whether their insurance covers it, what happens if their condition worsens, and how quickly a clinician can arrive.
Hospital at home is not designed for emergencies. Chest pain, trouble breathing, sudden confusion or signs of stroke still require a 911 call. The next test is whether evidence gathered before 2030 persuades Congress to make the model permanent, and Cone’s decision suggests that payer coverage, patient volume and staffing, not the waiver alone, will decide which programs last.
Key Questions Answered
What is Cone Health ending?
Cone Health in Greensboro, North Carolina, is ending its hospital at home program during the fourth quarter. It said current patients will keep receiving care during the transition.
Why is Cone ending the program?
Cone cited a review of its priorities and the model’s sustainability, pointing to shifting reimbursement, operational complexity, and long-term viability concerns across the industry.
Is the Medicare hospital at home waiver still active?
Yes. Congress extended it through Sept. 30, 2030, in a law signed Feb. 3, 2026.
How many hospital at home programs exist?
As of March 2026, the American Medical Association reported 366 approved programs across 139 health systems in 37 states.
What should current patients ask?
Ask how follow-up visits, prescriptions, equipment returns and after-hours calls will be handled during the wind-down.
Is hospital at home appropriate for emergencies?
No. Call 911 for chest pain, trouble breathing, sudden confusion or signs of stroke.
Published by Medicaldaily.com
