Mount Sinai Visiting Doctors

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Mount Sinai Visiting Doctors
Linda DeCherrie, MD Assistant Professor of
Medicine and Geriatrics Associate Director, The
Mount Sinai Visiting Doctors Program
Photographs by Ana Blohm, MD
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Visiting Docs History

• Started in 1995 by three medical residents
• Primary and palliative care services for
  homebound
• Currently the largest academic home bound primary
  care program in the country 1000 patients
  annually

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Visiting Docs Mission

• To provide a full spectrum of medical and
  psychosocial services to the homebound
• To alleviate caregiver burden
• To reduce unnecessary emergency room visits and
  hospitalizations
• To educate and train medical trainees and other
  healthcare professional students in the field of
  home care

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Visiting Docs

• Staffing
• 13 home visit physicians (8FTE)
• ½ day per week home visit psychiatrist
• 2 nurse practitioners
• 3 social workers
• 2 office-based RNs
• 6 office and administrative assistants
• Spanish interpreter
• Data analyst/ research coordinator

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Trainees

• 140 medical students required in 3rd year 1 week
• Medicine R2s 1 month rotation
• Med-Peds R4s 2 week rotation
• Geriatrics and Pall care fellows1 month
  longitudinal experience
• Elective trainee visiting geri fellows, psych
  interns, elective students, 4 year students

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What Makes Us Thriving?

• Teaching
• Research
• Large clinical practice
• Well-regarded by the institution
• Lasting partnerships with community agencies

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But teaching hospitals care about the bottom line
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Academic Environment is a Challenge to Sound
Business Practices

• Full time clinical practice and academic
  advancement are not compatible. 0.5 FTE at an
  academic center rarely equals 50 clinical
  productivity
• Academic medical centers dont have a great track
  record of capturing professional billing dollars
• Each day of teaching 30-50 decrease in number
  of home visits per day

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In Reality

• Revenues collected from home visits (and care
  plan oversight, and home care certification) will
  not cover expenses in programs with a major focus
  on trainee education

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So where do the other dollars come from?

• Grants
• Philanthropy
• GME Dollars
• The Medical School Dean
• The Hospital System

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Home Visit Programs as a Driver of Inpatient
Admissions

• Brings medically complex patients into the
  healthcare system
• No care in past year (25)
• Many from other hospital systems
• Mostly Medicare and/or dually eligible
• 1 admission per patient per year
• 6000 CM per admission

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Home Visit Programs as a Buffer to Preventable
Admissions

• Tertiary care centers increasing focus on
  high-intensity, procedure-driven admissions
• orthopedic, cardiac, surgical
• Want to limit admissions and LOS of low-intensity
  patients
• e.g. CHF/COPD exacerbations, pna, UTI
• Home visit programs can limit admissions to only
  those most necessary can d/c from ED facilitate
  d/c planning

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Lessons learned/How to sustain a thriving practice

• Track your patients
• Track impact on medical center
• Keep in touch with stakeholders