New Program to Provide Hospital-Level Care at Home

The federal Centers for Medicare and Medicaid Services (CMS) has awarded $9.6 million to Icahn School of Medicine at Mount Sinai to establish a Mobile Acute Care Team (MACT) program that provides patients with eligible medical conditions the same level of acute care they would receive in the hospital, but in their home environment.

Over the next three years, hundreds of patients in multiple Mount Sinai Health System emergency departments will be given a choice of whether they want to be treated as an inpatient or join the MACT program and be treated at home.

Under the three-year CMS Health Care Innovation Award, Mount Sinai, through its Visiting Doctors Program, will partner with community organizations such as Visiting Nurse Service of New York to provide Medicare and Medicaid patients with in-home care for acute medical conditions that include cellulitis, chronic obstructive pulmonary disease (COPD), community acquired pneumonia, congestive heart failure, deep venous thrombophlebitis, diabetes, and urinary tract infection. The Mount Sinai Visiting Doctors Program conducts more than 6,000 annual primary care and end-of-life visits to elderly and home-bound patients in Manhattan.

“Delivering acute care in the home is an example of medicine advancing in every way,” says Theresa A. Soriano, MD, MPH, Associate Professor of Medicine, and Geriatrics and Palliative Care, and Executive Director of Mount Sinai Visiting Doctors and Chelsea-Village House Call programs. “It will allow the Mount Sinai Health System to improve patient satisfaction.”

This is the second time in two years that Icahn School of Medicine has received a CMS Health Care Innovation Award, with the goal of creating new ideas and models of delivery that lead to improved care and lower costs for people enrolled in Medicare and Medicaid.

MACT was modeled after the Hospital at Home program developed several years ago at The Johns Hopkins University. The University conducted a yearlong study comparing 323 acute care patients treated at home with 1,048 hospital inpatients, and found that home-based care reduced the cost of acute care by roughly 20 percent. In addition, Hospital at Home patients had slightly lower hospital readmissions and mortality rates, and higher satisfaction scores.

“We are proud that CMS recognizes the ability of MACT to transform the clinical and financial health care model for individuals with these acute illnesses, and that we, as a health system, are demonstrating the viability of in-home health care as a cost-effective means of improving health outcomes,” says Albert L. Siu, MD, Ellen and Howard C. Katz Chairman’s Chair of the Brookdale Department of Geriatrics and Palliative Medicine at Icahn School of Medicine at Mount Sinai.

MACT is expected to serve a total of roughly 700 acute-care patients in Manhattan with teams comprised of physicians, nurse practitioners, nurses, social workers, and community health workers. The teams will provide daily medical visits and arrange for necessary medical equipment, medications, and laboratory services to be supplied in patients’ homes. A clinical team will be on call at all times and patients will have access to rapid medical services and medications.

Through MACT, Mount Sinai will be able to create a reasonable payment model for high-level home-based acute care that CMS can adopt and implement. Currently, CMS does not have a payment code for hospital-level outpatient care.

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