Mount Sinai at Home, Other Hospital-at-Home Models Proving Value Amid National Emergency

As health care experts eye the next two weeks as possible peaks for the nation’s COVID-19 hotspots, hospital systems continue to search for innovative ways to increase their capacity.

So far, those solutions have included converting skilled nursing facilities (SNF) into coronavirus-specific field hospitals and bringing in U.S. Navy medical ships for added support. Hospital-at-home programs are also beginning to gain more momentum, something that Home Health Care News predicted would happen more than three weeks ago.

“In times of crisis, things that people wouldn’t normally think about or things they would think about sort of on a slow-burn basis start to get some traction,” Bruce Leff, a hospital-at-home expert and the director of the Center for Transformative Geriatric Research at Johns Hopkins University School of Medicine, previously told HHCN. “Crises have a way of making things happen.”

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One such hospital-at-home program making inroads is Mount Sinai at Home, housed out of New York City-based Mount Sinai Health System.

Launched in 2014 as part of a three-year CMS Innovation Center grant, Mount Sinai at Home has been actively working to free up beds across Mount Sinai’s eight hospital campuses. It’s doing so by shifting certain vital services into the home for patients nearing the end of their in-patient stays.

“We began thinking about how we could use hospital-at-home to meet the needs of our hospital system in our community, in terms of responding to the crisis of COVID-19 in the context of the [Gov. Andrew Cuomo’s] state of emergency,” Al Siu, director of Mount Sinai at Home, told HHCN in mid-March. “What we have done is made various [moves] to be able to take care of a number of subsets of patients. We believe doing that will help create some hospital capacity to take care of patients who truly need our hospital beds.”

In some cases, for example, that could mean continuing IV-antibiotic treatment at home instead of in the hospital. With patients that require general monitoring, it could mean shifting daily nursing services into the home, paired with physician monitoring and select laboratory testing.

“Rather than focusing on specific diagnoses, our focus has been on specific services that we’re able to render at home — and whether those are the services that are keeping the patient in the hospital,” Siu said.

Since Mount Sinai at Home’s CMS Innovation Center grant concluded, the hospital-at-home program has operated by contracting with various payers, including MA plans. It additionally has teamed up with Nashville, Tennessee-based Contessa Health, which assists with the negotiation and management of those contracts while helping with certain aspects of care coordination.

Currently, Mount Sinai at Home has contracts with four health plans in its market, with plans “to bring on a number of other health plans” in 2020, according to Siu.

But due to amended contracts and memorandums of understanding related to COVID-19, Mount Sinai at Home is now working with “almost all payers” in light of the pandemic.

New York recorded its biggest one-day increase in deaths from COVID-19 on Tuesday, as 731 fatalities brought its overall tally to nearly 5,500. There are now more than 138,800 cases of the virus in the state.

Mount Sinai at Home is one of the most well-known hospital-at-home programs in the country, but it’s not the only one on display as part of the coronavirus response.

In December, Denver-based DispatchHealth announced it would start delivering comprehensive medical care in the home setting as an alternative to hospital admissions. In addition to hospital-level care in the home, DispatchHealth offers an array of in-home urgent care services.

As coronavirus initially began to spread in the U.S., DispatchHealth saw a 40% increase in its requests for care, a company spokesperson told HHCN in March.

“Our goal is to keep the most vulnerable patients home and out of crowded environments,” the spokesperson said in an email. “We intend to see anyone and everyone who requests and needs care. As long as our teams and others have appropriate [protective personal equipment], we will visit, evaluate and ensure patients recover at home — or escalate to a higher level of care if needed.”

While Mount Sinai is decanting its hospitals by shifting several different types of patients into the home setting for care, a different hospital in the Seattle area is using a hospital-at-home approach to specifically care for lower-acuity COVID-19 patients.

An official from the hospital shared information with HHCN on an on-background basis.

Medical evidence suggests that about 15% of COVID-19-positive patients need hospital-level care, with roughly one-third of those needing ICU-level care, according to a strategic plan that the Seattle-area hospital shared with HHCN. As part of its approach, the hospital is aiming to manage “a significant portion” of those non-ICU COVID-19 patients in the home by supplying oxygen and monitoring patients’ conditions with Bluetooth-connected pulse oximeters.

“As the virus continues to spread in our community, this could potentially enable us to avert hundreds of hospitalizations,” the plan stated.

While Mount Sinai at Home and similar efforts are proving their mettle amid the COVID-19 emergency, it might be difficult for new hospital-at-home programs to pop up during this time, Siu noted.

“If you do not have an existing program that you could expand or the existing experience with hospital at home, it would be difficult to do this in a turnkey [fashion] as we need today,” he said.

Furthermore, Siu added, for hospital-at-home models to work, they typically need strong home health partners.

Many home health providers are dealing with COVID-19 challenges of their own, perhaps leaving them unable to support hospital-at-home programs.

“I think it’s also important to touch on how important it is for our home health agencies to have capacity to take on these patients,” Siu said. “Even if we identify them, we will not be successful unless we also have partners with the capacity to take on some of these patients in the community and at home.”

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