Access to high-quality care is a core part of our mission and a core part of all quality care definitions. One of the major activities of Mount Sinai Medical Center medical staff has been providing care in our communities. Many of you care for patients in your offices at our main campus, and many see patients in many other sites around Miami-Dade and Monroe counties. Our Mount Sinai Primary and Specialty Care offices are now in 11 locations, in addition to our main campus. Plus, many physicians have other sites where they see patients. These community offices provide high-quality, Mount Sinai Medical Center care in a convenient manner to thousands of patients each year. There are many office locations in addition to our two freestanding Emergency Centers in Aventura and Hialeah. 

The physicians caring for patients and the many services such as lab testing, imaging, radiation therapy, infusion care, cardiac testing, and urology testing provide important access for many patients. Physicians provide care in internal medicine, pulmonary, cardiology, gastroenterology, general surgery, surgical oncology, colorectal surgery, vascular surgery, neurosurgery, orthopedics, and obstetrics and gynecology. We are in the planning phase for our elder care (PACE) program to open in Hialeah in 2023.

Our satellite locations provide learning opportunities in addition to patient care. Our internal medicine, surgery, podiatry, and cardiology fellows, in addition to all our residents, can work with teachers in our satellite offices. We are beginning a primary care sub-internship multisite rotation in collaboration with Nova Southeastern Medical School to train students for careers in primary care. This program is based in our Hialeah and Aventura locations.

As we continue to expand access for all, we are also focused on providing personalized care. We have implemented testing and information for patients who would like to know their pharmacogenomics and risks. We have partnered with ACTX ( ACTX.com), allowing us to integrate testing and results into our EPIC electronic health record. To learn more, please refer to the ACTX website and our tip sheet for ordering the test.

Care for Elders

Mount Sinai Eldercare: A New Option for Seniors With Challenging Health Conditions

Mount Sinai Medical Center continues to promote its mission of providing high-quality health care to our diverse community by adding a new option for seniors, known as Mount Sinai Eldercare. Mount Sinai Eldercare is a Program for All-Inclusive Care for the Elderly (PACE).

PACE is a national program of comprehensive care for adults ages 55 and over who would prefer to remain living at home rather than in a nursing facility. They must meet the criteria for nursing facility placement and have an assessment indicating that living at home with the support of the PACE program is a safe alternative. PACE promotes independence and the highest levels of functioning while allowing choice and dignity for members and their families.

Mount Sinai Eldercare covers all services provided by Medicare and Medicaid and other services deemed necessary to support the member’s goal of living at home. 

The following list includes some of the key factors that may be used to determine PACE participant eligibility.

The individual:

• Needs help with daily activities, such as bathing, walking, dressing, eating, meal preparation, and light housekeeping
• Uses insulin or oxygen
• Needs assistance managing his or her medication
• Has skilled care needs, such as nursing, physical therapy, and occupational therapy
• Cannot afford insurance co-pays or deductibles
• Needs a wheelchair, walker, or other types of medical equipment
• Has complex health needs
• Family/caregivers are struggling to keep their loved one at home due to family and work commitments
• Has difficulty keeping up with his or her medical care

The average PACE participant:

• Eligible for nursing home care, but 95% continue to live at home
• 77 years old
• Females make up 70% of the enrollment
• Comorbid, with the top five diagnoses being vascular disease; diabetes with chronic conditions; congestive heart failure; major depression, bipolar, and paranoid disorders; and chronic obstructive pulmonary disease
• Over 50% need assistance in 3-6 ADLs
• Nearly half have dementia or Alzheimer’s
• Taking at least six different types of medications
• Participant and/or family utilize a lot of health care resources

Mount Sinai Medical Center physician awareness and support of Mount Sinai Eldercare is essential to Eldercare’s success. Please contact Lymari Rivera, director of business development, at 954.709.1291 or Lymari.Rivera@eldercare.msmc.com for more information. 

Mount Sinai Eldercare’s enrollment is projected to start in May 2023.

 Care Planning in our ICUs

We have started a new policy: Quality Life and Protection of Dignity Management. Our Medical Executive Committee supports this new policy. This new policy requires a conversation with certain ICU patients about palliative care. Patients who meet specific criteria relating to their clinical condition such as neurologic impairment or metastatic cancer and, in addition, have utilization criteria such as readmissions to the ICU or long length of ICU stay must have a palliative care consult. This policy may be read in our PolicyStat system, which is accessed via Sinai Connection.

Admitted Patients Delayed in Our Emergency Center

When patients are admitted but remain in our Emergency Center for several hours awaiting a bed, we must continue to provide excellent care. The admitting physicians should see these patients early in the morning, be sure to communicate with the Emergency Center doctors and nurses, and have admission orders written and discussed. We should evaluate the patients on a regular basis, depending on their clinical condition. We should also evaluate to see if the patient is being admitted to the correct location or in some cases, whether the patient can go home.

Discharge Planning

A key process to help us all is discharge planning. Our care managers see patients at admission and do an assessment for discharge. Discharge planning requires a full team process. We, as the physicians, lead this team. We make the care, testing, and discharge decisions. We need to ensure that all the physicians seeing the patient, the patient’s family, nurses, and the care manager all know our discharge plans as early as we do. This requires verbal communication with the team members, in addition to our electronic health record documentation. We know it takes 4-5 hours to discharge a patient, once nursing is informed. Our goal is to have patients discharged by noon, and this is best achieved by team communication a day in advance of discharge.

Indicating an expected discharge date is an important part of team communication. Please indicate in EPIC and communicate verbally to patients and families as well as our care managers, nurses, and consultants what you are thinking of as a likely discharge date.