Mount Sinai Health System receives waiver from CMS to scale up hospitalization at home

Dec. 1, 2020

The U.S. Centers for Medicare & Medicaid Services (CMS) announced that the agency had approved a waiver allowing Mount Sinai Health System to enroll a broader group of Medicare patients into its Hospitalization at Home (HaH) program. The move is a game changer as hospitals in New York City brace for a continued increase in COVID-19 cases. 

“The CMS has taken an extraordinary step today, facilitating the rapid expansion of Mount Sinai’s Hospitalization at Home program, an innovative care model with proven results. This means we can significantly scale up hospital-level services in the home, while enhancing hospital capacity for a potential surge,” says Kenneth L. Davis, MD, President and Chief Executive Officer of Mount Sinai Health System. 

The concept of “hospitalization at home” has received widespread attention during the pandemic as concerns about the vulnerability of older Americans have mounted. With this home-based care model, patients receive hospital-level services in the safety and comfort of their home, reducing their risk of being exposed to COVID-19. 

Mount Sinai Health System was one of the earliest adopters of the concept, and one of the first to prove that it works. In 2018, Mount Sinai researchers led by Albert Siu, MD, MSPH, reported in JAMA Internal Medicine that both clinical outcomes and patient experiences were vastly improved with hospitalization at home care, resulting in shorter length of stay; reductions in hospital readmissions, emergency department visits, and transfers to skilled nursing facilities; and improved patient experience versus traditional inpatient care. The study was funded by a Health Care Innovation Award from the Center for Medicare & Medicaid Innovation (CMMI) and The John A. Hartford Foundation. 

“While we were collecting this critical evidence base, we started to work closely with CMS and provide input on the model and how it could be leveraged more broadly and more strategically,” says Dr. Siu, Chair Emeritus of the Brookdale Department of Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mount Sinai. “We were able to bring hospital-level services into the homes of our patients throughout New York City, but the one obstacle we faced was, how do we pay for this? To facilitate widespread adoption, we needed a mechanism of reimbursement that would capture a larger portion of the Medicare population.” 

During the peak of the pandemic, Mount Sinai’s Hospitalization at Home, a joint venture with Contessa Health, a Nashville-based health care company that manages acute care services at home, ramped up its services, reaching a critical milestone: admitting its 1,000th patient. 

“The pandemic propelled the program’s momentum forward in March when patient beds became scarce. Our team jumped in to help, as we moved inpatients to their homes, while freeing up much-needed beds. Previously our patient population was limited to adults who showed up in our emergency department,” says Linda V. DeCherrie, MD, Professor of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, and Clinical Director of Mount Sinai at Home, which includes Hospitalization at Home and Mount Sinai Visiting Doctors. 

While collaborating closely with CMS, Drs. DeCherrie and Siu co-lead the Hospital at Home Users Group, alongside Bruce Leff, MD, Professor of Medicine, Johns Hopkins University School of Medicine, where he directs the Center for Transformative Geriatric Research, and David M. Levine, MD, a practicing general internist and clinical investigator at Brigham Health and Harvard Medical School, who directs Brigham’s home hospital program. 

The Hospital at Home Users Group is a collaborative of Hospital at Home programs that works with other home-based care models to develop standards and inform regulatory and reimbursement policies necessary to spread this hopeful model broadly throughout North America. 

Mount Sinai has the release.