New York City-based Mount Sinai Health System has doubled its hospital-at-home program over the past year, its leader told Becker's.
The health system already has one of the oldest hospital-at-home offerings in the country, starting in 2015, before the CMS waiver that propelled many health systems to launch the care model. So Mount Sinai has learned to provide acute inpatient care at home in the face of regulatory uncertainties.
Mount Sinai's hospital-at-home initiative has grown from an average daily census of 15 to 20 a year ago to 25 to 30 today. But the eight-hospital system might have been able to expand the program even more if not for one thing.
"The biggest barrier is not actually patients, but more staff," said Ania Wajnberg, MD, president of Mount Sinai at Home. "It's a very people-heavy business."
Like some other states, New York requires the twice-daily in-person visits for hospital-at-home patients be provided by nurses rather than paramedics.
"So it's slow and steady growth," Dr. Wajnberg said. "But we're also focusing on taking a wider array of diagnoses to help support that growth and to offer a wider array of treatments in the home."
That includes patients who need dialysis, post-surgical care, or monitoring for complex cardiac conditions.
"Our pool of providers continues to grow. The buy-in from Mount [Sinai Health] System is going very well," Dr. Wajnberg said. "People are getting used to this as an accepted model and looking for it to improve patient care and length of stay in the hospital."
An extension of the CMS waiver for hospital at home that ends Dec. 31 has been working its way through Congress in recent months. Mount Sinai has been at this so long it has contracts with payers outside of Medicare.
"The next few weeks will really help in terms of getting some of the programs invested that are newer," Dr. Wajnberg said. "Because we've been in this space for a long time, people contact us frequently and ask how to handle that type of uncertainty. But the waiver will go a long way in terms of reassuring people and getting programs off the ground."