Medical waste in hospital-at-home settings creates costly conundrum

Hospital at home has a bit of a waste disposal problem, it seems.

While hospital-at-home care was only intended to temporarily increase hospital capacity during the Covid-19 pandemic, continued extensions have turned it into a more fundamental part of a hospital’s care offerings. As of Jan. 23, there are 373 hospitals approved for at-home care across 140 health systems.

With that, however, comes an increase in medical waste outside of a hospital room’s walls.

Hospitals themselves aren’t exactly known for having a low carbon footprint when it comes to waste and knowing what can or can’t be recycled. A 2020 study found one emergency department accumulated 671.8 kilograms of waste in a day, with only about 15% marked as regulated medical waste.

According to a 2023 report from medical waste compliance company Stericycle, the top challenge to clinicians working in hospital-at-home settings is managing pharmaceutical and medical waste. More than half of the healthcare professionals polled (58%) said they knew proper waste disposal methods and over 90% felt more resources were needed to help them understand what to do with waste.

“Part of the reason that some of this stuff is moving into the home is to make things easier for [patients], giving them care someplace that they’re comfortable—so putting more burden on them by giving them responsibility for waste management, to me, seems like a mismatch,” Kristin Aldred, director of government affairs at Stericycle, told Healthcare Brew.

Risky business. Having an increase in sharps, pharmaceuticals, and waste—especially items that might have infectious material on them—could create a “higher potential risk in terms of safety for healthcare workers, for patients, for members of the family, caregivers, for waste workers if that material is not properly handled and disposed,” Aldred said.

Options exist for some product disposal, she added, like mail-back envelopes, FDA-cleared sharps containers, or even directing used products back to a central location.

But despite rules for properly disposing of sharps, a 2018 study by nonprofit the Environmental Research and Education Foundation still found 30% of respondents encountered needles or syringes a few times a week at polled waste recovery agencies.

Hospitals also have more stringent rules to comply with for waste disposal as well as the resources to ensure proper protocols are followed, but hospital at home doesn’t necessarily have to comply with these structures, Tinglong Dai, Bernard T. Ferrari professor of business at Johns Hopkins University, told us.

Cost considerations. And as with most pain points in healthcare, cost is a major factor, Dai added.

“We really have to think about the total cost of providing care and use that basis for deciding whether a patient should be in a hospital or we should do hospital at home,” he said.

A 2024 study from the Centers for Medicare and Medicaid Services found at-home care 30-day post-discharge spending was “significantly lower” by $1.6 million, or 22.1%, than traditional hospital care for 13 of the top 25 Medicare Severity Diagnosis Related Groups, a CMS system used to categorize and reimburse inpatient hospital services.

From there, Dai continued, “we have to rethink this reverse supply chain” on how to collect, transport, and process waste from at-home settings to regulated facilities—sort of like a fulfillment center for processing medical waste. But that would require proper budgeting and could be “very expensive,” he said.

“Right now, [at-home waste disposal is] not on most people’s radar yet,” Dai said. “I think we really need to be proactive about regulation…otherwise, I don’t think anyone’s going to do anything right now.”