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The Ohio expansion
On March 25, Cleveland Clinic announced it is extending the model it began in Florida in 2023 to Fairview and Avon hospitals on Cleveland’s west side. Eligible patients must live within 25 miles of either hospital and are identified in the emergency department or on an inpatient unit. Conditions include COPD, sepsis, cellulitis, pneumonia, asthma and select colorectal surgery recoveries. Cleveland Clinic said more than 4,000 Florida patients have recovered at home under the program.
The timing reflects firmer federal footing. The Consolidated Appropriations Act, 2026 extended the Medicare Acute Hospital Care at Home waiver through 2030, and the American Medical Association counted 366 approved programs across 139 health systems in 37 states.
What a scalable program requires
Cleveland Clinic’s design shows the operating backbone involved. A virtual command center staffed by physicians, advanced practice providers, pharmacists, coordinators and nurses monitors patients around the clock and can dispatch an ambulance or care team. In-person staff handle blood draws, mobile X-ray and ultrasound, and IV therapy. Patients receive a tablet, a direct phone line, an emergency bracelet, vital sign devices and backup power.
Each of those elements is a cost and a dependency. Programs that stay small tend to struggle because the fixed costs of round-the-clock monitoring and dispatch capability are spread over too few patients. Programs that scale need dependable referral pathways from the emergency department and hospitalist teams, clear eligibility criteria, and vendors that can deliver equipment and services on short notice.
Questions for leadership
- Capacity value: How many inpatient bed-days could a home program free up at our busiest campuses, and what is that capacity worth in avoided construction or diversion?
- Payer mix: The waiver covers traditional Medicare. Which commercial and Medicare Advantage plans will pay for home-based acute care, and on what terms?
- Workforce: Can we staff a virtual command center and mobile teams without pulling nurses from understaffed units?
- Quality oversight: Are home patients included in the same safety reporting, escalation and readmission tracking as inpatients?
- Geography: Which service areas are dense enough to support timely in-person visits?
Archive entry for Mar 25, 2026, added Nov. 11, 2026.