Healthcare is undergoing a major transformation as alternate care sites become a preferred setting for a growing number of procedures. From dialysis to cardiac monitoring to orthopedic surgeries, these flexible, less acute settings are offering new advantages for patients, providers, and payors.

At LSI Europe ‘24, a panel of industry leaders explored the migration of care away from traditional hospital settings and into ambulatory surgery centers (ASCs), home environments, and specialized outpatient clinics. Moderated by David Uffer, Managing Director, MedTech, Trinity Life Sciences, the discussion featured insights from:

• Osman Khawar, CEO of Diality, on dialysis and the shift toward home-based treatments.
• Tim Fitzpatrick, Co-Founder and former CEO of IKONA, on the importance of patient education in these new care models.
• Amos Ziv, Founder, CSO, and interim CEO of CardiaCare, on remote monitoring and wearable-driven cardiac care.
• Addie Harris, former CEO of HAVENTURE, on how technology is responding to the demand for ASCs.

Their discussion revealed the key drivers behind the rise of alternate care sites, the challenges of adapting technology for these environments, and how reimbursement models are evolving.

Why Are Alternate Care Sites Growing?

The migration of care from hospitals to alternate sites isn’t just a trend—it’s an economic and clinical necessity. Osman Khawar pointed to two primary forces driving this shift:

“What I’m seeing across the spectrum, including dialysis, is two advantages: clinical advantages and economic advantages. When both of those come together, it becomes relatively powerful to move the sites of service outside.”

For dialysis patients, at-home treatment options have grown due to support from CMS and value-based care initiatives. “We’re seeing models like ESCOs and CKCC take full patient risk,” Khawar explained. “The goal is reducing hospitalizations and driving patients home.”

But it’s not just about policy. Patient demand is playing a major role. “When you look at surveys of patients and providers, there is a big push to move more patients to home-based care,” said Khawar. “Physicians say that if they had the appropriate support, they would try to place a majority of their patients in the home environment.”

The same shift is happening in surgery and orthopedics. Addie Harris explained:

“Hospitals are becoming more crowded, and there’s a shortage of healthcare workers. For patients who don’t need very acute care, it makes sense for the hospital to not take those patients into ORs that are busy with cardiac cases or more complex procedures.”

As technology evolves, more procedures—like knee replacements and spinal surgeries—are moving to ASCs. These settings allow for lower-cost procedures with faster recovery times, benefiting both patients and payors.

How Technology Is Adapting to Alternate Care Sites

While the benefits are clear, shifting care outside hospitals requires technology that is easier to use, more portable, and designed for different staffing levels.

For robotic-assisted surgery, this means designing systems that work across multiple procedure types.

“Historically, we’ve seen robotics and navigation systems developed for specific procedures,” Harris said. “Now, companies realize that an ASC may have a sports medicine doctor on Wednesday, a hip surgeon on Friday, and a spine surgeon on Monday. They need technology that can adapt across all these specialties with a single system.”

In dialysis, usability is critical. Khawar explained that Diality designed its device with the home setting in mind from the start:

“If you can get a layperson to use your device, that’s a success—not just in the home, but in any alternate site of care. We focused on consumer-friendly usability and automation, reducing the burden on the user while improving safety.”

Cardiac care is also embracing this shift. Amos Ziv’s company, CardiaCare, is pioneering wearable-driven treatments for atrial fibrillation (AFib). Instead of episodic hospital visits, patients can now monitor and treat their condition in real time.

“Patients with AFib visit the ER often, especially early after diagnosis,” Ziv said. “Connectivity and IT advancements now allow us to provide treatment at home using a wearable that balances the autonomic nervous system. This expands access to care, especially in underserved areas.”

The Reimbursement Challenge: Aligning Payment Models with New Care Sites

As alternate care sites grow, reimbursement models must evolve. Some specialties, like robotic surgery, still lack clear reimbursement pathways.

“There’s no reimbursement for robotics and navigation procedures,” Harris noted. “There is a code, but it’s rarely reimbursed. Yet, direct-to-consumer demand and patient preference are driving adoption.”

In dialysis, reimbursement structures remain a significant hurdle. While treating patients at home is more cost-effective in theory, current payment models don’t always align with that reality.

“CMS wants more patients at home but hasn’t figured out how to pay for it,” Khawar explained. “Right now, home dialysis is reimbursed at the same rate as center-based dialysis, despite the clear cost savings.”

Education is also affected. Tim Fitzpatrick pointed out that Medicare does reimburse for kidney disease education, yet utilization remains under 2%.

“Even when reimbursement exists, the process is complex,” Fitzpatrick said. “Providers avoid it because of the back-office work required.”

The biggest opportunity for reimbursement evolution lies in value-based care models. As providers take on full risk for patient populations, they’ll increasingly look for technologies that reduce hospitalizations, lower costs, and improve patient outcomes—regardless of traditional reimbursement challenges.

The Future of Alternate Care Sites

The panelists agreed: the future of healthcare innovation is not in hospitals alone.

“The days of hospitals holding patients for long periods or treating less acute patients are coming to an end,” Harris said. “Care centers outside of hospitals will increasingly become the standard, not the exception.”

For chronic care patients, at-home monitoring, wearables, and virtual education platforms will empower them to take charge of their own health.

For surgical care, ASCs will continue to grow, supported by technology that adapts to multiple specialties and minimizes staffing needs.

For dialysis, the future lies in simplified, consumer-friendly devices that allow more patients to receive care at home—provided that reimbursement models catch up.

“Hospitals will always be necessary for acute care,” Ziv noted. “But chronic care and monitoring will continue shifting to the home, allowing patients more control over their health.”

As medtech evolves, the ability to design, commercialize, and reimburse for technologies in alternate care sites will define the future of healthcare.

Final Thoughts

The rise of alternate care sites is more than just a shift in location—it’s a fundamental rethinking of how and where care is delivered. With economic, clinical, and patient preference factors all aligning, the move outside of hospitals is accelerating across renal, cardiac, and surgical care.

For medtech companies and investors, success will depend on designing technology for these new care models, aligning with evolving reimbursement structures, and ensuring seamless patient and provider adoption.

Want to hear more insights like this? Join us for our next medical technology conference in Dana Point, CA, next week.