‘Unacceptable’: Hospital-at-home, telehealth programs disrupted by shutdown

Telehealth programs, including hospital-at-home programs, have become collateral damage in the federal government shutdown.

Congress and the White House failed to broker a deal on a new spending bill, and the previous bill only paid for federal programs through Sept. 30, triggering a partial shutdown of the government. Democrats have been pushing to extend tax credits for the Affordable Care Act, a key element in the stalemate.

The now-expired spending bill also included short-term waivers authorizing hospital-at-home and telehealth programs, which also expired Sept. 30.

Hundreds of hospitals providing acute care at home have been directed by the Centers for Medicare & Medicaid Services to return their patients to hospital or discharge those patients. Millions of Americans use Medicare to pay for virtual care programs, particularly for mental health services, but now they won't have telehealth visits reimbursed.

Kyle Zebley, executive director of ATA Action, the advocacy arm of the American Telemedicine Association, tells Chief Healthcare Executive® that telehealth programs still enjoy strong support in Congress. He says a new spending deal will likely include temporary waivers extending those programs.

But that doesn’t minimize the problems and frustrations for health systems around the country with the interruption.

“It’s devastating. It's unacceptable,” Zebley says. “We shouldn't be in this situation.”

“Despite our broad-based bipartisan support, that we acknowledge and are grateful for, this is no way to run a health care system. This is no way to leave Americans in the lurch, and yet, here we are,” he says.

As of Tuesday afternoon, Zebley said CMS hasn’t provided official guidance that would direct providers to continue telehealth programs and get reimbursement later.

“Even then, I would think there would be questions around whether or not Congress will definitely include a retroactive provision allowing for payments after the fact that would have occurred during the lapse,” Zebley says.

Impact on hospitals

The American Hospital Association said in an email to Chief Healthcare Executive® that guidance from the government leaves hospitals little ambiguity. Health systems need to bring patients in hospital-at-home programs to brick-and-mortar facilities or discharge them. Health systems also are prohibited from enrolling patients into hospital-at-home programs.

“Lapse of hospital-at-home waivers will cause significant disruption for the patients who are receiving hospital-at-home services from the over 400 hospitals across 142 systems and 39 states that have programs approved by CMS,” the hospital association said in a statement.

About 31,000 patients have been treated in hospital-at-home programs through October 2024, according to CMS data.

With hospital-at-home programs, patients receive some services virtually, but participating health systems are required to send nurses to see patients in person at least twice per day. Patients can also talk to physicians online.

Advocates expect that a new spending bill will almost assuredly include extensions for telehealth programs, but they are likely to be short-term extensions.

“We would like to get out of this short-term cycle,” Zebley says. “It makes absolutely no sense. It doesn't allow us to take full advantage of these flexibilities. We need to get to permanency, and if not permanency, the longest, longest extension possible.”

The recurring worries over waivers have flustered providers of telehealth and hospital-at-health programs.

Congress and then-President Biden approved a two-year extension of telehealth programs that expired at the end of 2024. Efforts for longer-term extensions have been unsuccessful, as lawmakers agreed on short-term extensions, first in December 2024 and then again in March.

Uncertainty slows growth

Healthcare advocates have been pushing for permanent extensions for telehealth, or at minimum, multi-year extensions so providers of telehealth and hospital-at-home programs can have more certainty in offering such services.

The ongoing budget battles and lack of predictability for telehealth programs makes it harder for providers to offer or expand services, Zebley says.

The lack of certainty is deterring some health systems from moving forward with hospital-at-home programs.

“It's only logical, and it's hardly a stretch of an imagination to say that we have not been able to take full advantage of the telehealth flexibilities in the acute hospital care-at-home program because of the uncertainty,” Zebley says. “And the biggest losers have been Medicare beneficiaries and the American people.”

The American Hospital Association also says that some health systems are reluctant to move ahead with new programs due to the inability to secure longer approvals for telehealth and hospital-at-home programs. Even if the budget stalemate is resolved quickly, health systems may be tentative about launching or expanding home-based programs.

“A lapse in waivers may also hamper long term progress for the hospital-at-home program, which has proven itself as an innovative and promising approach to providing high-quality care. Other health systems and hospitals have indicated they are interested in standing up hospital-at-home programs but are hesitant to do so without a long-term extension from Congress,” the association said in its statement.

‘Overwhelmingly frustrated’

Providers say hospital-at-home programs give patients the acute care services they need with many favorable advantages of being outside the hospital. Patients can typically get more sleep at home, loved ones don’t have to travel back and forth, and patients can generally be more comfortable. Researchers have found hospital-at-home programs have low mortality, as evidenced by a 2024 study in the Annals of Internal Medicine.

Even with telehealth use dropping from the peak of the pandemic, millions of Americans use virtual providers. Telehealth has proven to be a popular avenue for patients to get behavioral health services. More than half of all telehealth visits involve patients seeking behavioral health treatment, according to Trilliant Health.

In light of the lapse of telehealth waivers and the persistent worry about renewals, providers are “unbelievably, overwhelmingly frustrated,” Zebley says.

Providers are tired of wondering if telehealth waivers will be extended.

“In a world where our federal government functioned a little bit better, I think it would have been made permanent long ago,” Zebley says. “They're frustrated because they're delivering high quality care to patients. They're frustrated because these programs and flexibilities are working. They're frustrated because the health care system is under duress and has less capacity than is necessary now, without the added body blows that a lapse of these programs would mean.”

Last December, Congress was on the cusp of approving a two-year extension for telehealth programs, and a five-year extension for home hospital programs, but those provisions were scrapped when the spending bill fell apart.

President Trump has shown strong support for telehealth, and there’s been no drop in support from lawmakers in Congress, Zebley says.

“We are just a victim of circumstance here,” he says. “Nobody is to get us. We're understanding of that. We're appreciative of it. We're grateful for the support. We'll never take it for granted.”

At the same time, Zebley is urging hospital and healthcare leaders to contact lawmakers and urge them to get a deal done and extend telehealth waivers.

“I think the power of shared collective voices to members of Congress, their staff, both the House and the Senate, folks that have connections with the administration should all pick up the phone, should all draft and send their emails,” he says.