Model Proposals - Organizational Capacity of Mount Sinai Hospital

Like all foundations, VNA enjoys partnering with nonprofits to create new programs which offer innovative solutions to problems facing the needy populations we seek to serve.

We also recognize, however, the importance of funding well-established programs or services addressing essential needs. We appreciated the following proposal from Mt. Sinai Hospital (to support home health care for the uninsured) for its clarity, simplicity and use of easily assessed and realistic outcome measures.

The proposal was approved in full by the VNA Foundation Board at its July 26, 2001 board meeting. We are pleased to offer it as the Proposal of the Quarter for the quarter ending September 30, 2001.

Here are some data that show why Mount Sinai Hospital and the Sinai Health System are vital to the families of the West Side:

• The rate of reported child abuse and neglect is sixth highest in the nation here.
• An estimated 360 households had incomes of less than $10,000 in 1998.
• Childhood poverty is extremely high in the area (as determined by the number of children eligible for the school lunch program in community high schools). In four of these high schools, more than 95% of students are eligible; in the remaining two schools, more than 75% are eligible.
• The high school drop-out rate exceeds 60%.
• The homicide rate is the highest in the city, more than double the city average.
• The birth rate of substance exposed infants is second highest in Illinois.
• The birth rate to mothers under the age of 20 is highest in Chicago.
• Mount Sinai Hospital has a combined charity and Medicaid percentage of approximately 75 percent. Though it cannot do so for all patients seen, the hospital bears costs that exceed traditional hospital healthcare costs.

Mount Sinai's Home Health Unit

Sinai's Home Health assists patients in making the transition from hospital to home and provides an array of services to those patients who meet the homebound criteria. The mission of Home Health is to provide quality quality health care and promote health and wellness for those needing skilled at home and wellness for those needing skilled care at home.

The unit provides the following services: skilled nursing; high-tech nursing; physical therapy; occupational therapy; speech therapy; medical social services; and home health assistance by aides.

Its services are provided in accordance with Medicare Conditions of Participation, the Joint Commission for the Accreditation of Health Care Organization's Home Care Standards, IDPH Rules and Regulations, and Departmental Policies and Procedures. .During its 1996 and 1999 accreditation reviews by the JCAHO, MSH Home Health received scores of 99 and 95 percent respectively- The unit has developed referral relationships with Home Physicians and Mobile Doctors and has become a preferred provider for the University of Illinois Hospital.

In FY2000, Home Health made more than 40,000 home visits. The unit is currently licensed to serve all of Cook County, providing multidisciplinary health ate to homebound patients in Chicago and its surrounding suburbs.

The unit has a staff of 33, which includes 14 RNs, four home health aides, a director, two nursing coordinators, and a business manager. Therapy services are performed in collaboration with schwab Rehabilitation Hospital, also a member of Sinai Health System. In FY 2000, Home Health visits increased 3 percent over the preceding year, totaling 40,616 visits, up from 39,332 in FY 1999. The average monthly Home Health patient census was 388, as compared with 331 the preceding year.

Home Health's breakdown of service by ethnic group for FY 2000 was African American, 77 percent; Hispanic, 11 percent; Jewish 6 percent, and other Caucasians, 6 percent.

The Need

In pursuit of its mission to provide quality health care and promote health and wellness for those needing skilled care in the home) Mount Sinai's Home Health unit serves three groups: the elderly and trauma victims who require such services) this last group generally includes those recently released from the hospital; and those having no insurance at all (the first two groups generally are underinsured, and Mount Sinai provides free care/assistance for them as well as for the third group.) Besides the visits themselves, unreimbursed Home Health costs include medications and supplies for many who otherwise would not have them. Nationally) according to a 1999 policy brief on Medicaid and the Uninsured prepared by the Kaiser Commission, the category of patients having no coverage from Medicaid, traditionally the insurer of the poor, has grown. Although Medicaid was never intended to insure all the poor, and certainly not the millions whose incomes hover just above the poverty level, expansions of the uncovered categories in Medicaid in the late '80s included a greater number of poor and near-poor children.

The greatest number of the uninsured, however, are those with low incomes, the "working poor," who are the primary population affected by decreases in job-based health benefits and recent declines in Medicaid enrollment. Nationally, some 25 million low-income individuals fall through the cracks in employer-sponsored health insurance just at the time when the gap in health benefits between low- and high-wage workers has grown. The low income wage earner most likely to be uninsured is an Hispanic male without dependents who works for a low wage at an organization having fewer than 100 employees, particularly in the agriculture and small business operations and repair services. About 40 percent of Mount Sinai's patients are Hispanics.

Medicaid coverage of this category began to fall in 1995. Welfare and immigration reform in 1996 "created unintended changes in Medicaid enrollment and a sharper drop in Medicaid coverage in 1997."

Of the approximately 388 patients visited by Mount Sinai Home Health last year, about 60 were completely uninsured. These patients received 800 completely unreimbursed visits from Home Health staff at an average cost of $60 per visit, thereby running up a total of $48,000 for this category in the last fiscal year.

Not only must the uninsured attempt to survive with practically no assistance for home health visits; they lack any assistance for supplies and medications, whose skyrocketing costs continue to gain media coverage.

The plight of the uninsured remains in striking contrast to those covered by Medicaid, who, if necessary, can receive on average as many as 29 visits per episode.

The Project
Home Health of Mount Sinai Hospital envisions a project that will enhance the level of care that the Hospital on its own could provide to the uninsured requiring home health care. In addition, funding from the VNA Foundation would allow development of data to support the long-term economics of preventing ER and hospital readmissions by providing a reasonable level of care. In addition, somewhat less than 25 percent of the requested grant will provide operating support to Mount Sinai, helping defray this year's projected cost for free home health care for the uninsured.

Project Goals
There are two overall goals for Mount Sinai's Home Health Care for the Uninsured Project

• Improving health care outcomes for uninsured men, women, and children, a group forgotten by the health care system;
• Providing a database on rates of readmissions to EMS and the hospital when a higher level of home health care is provided.

Outcome Objectives
A decrease of six percent of the number of uninsured patients who are:

• readmitted to EMS because of lack of medication;
• readmitted to EMS because of lack of nursing care.

A decrease by five percent of the current number of hospital readmissions for uninsured individuals by providing the required level of care--or very close to it (as the requested grant and Mount Sinai' s projected allowable care level will allow. )

Process Objective
The project will set up a database and data collection system for this group of patients who are generally dealt with as economically as possible (in other words, there is little information on them). In the first portion of the project, data from the preceding year will be reconstructed to provide a baseline for comparison with the enhanced levels of care that would be available this year with grant approval. Particular emphasis will be on the items in the outcome objectives: 1) readmission to EMS because of lack of medication and lack of nursing care; and 2) readmission to the hospital.

Project Evaluation
The Home Health Director will evaluate the unit's progress toward objectives by monitoring outcome objectives and the process objective on a month-to-month basis, reporting on this progress as required by the VNA Foundation.

Mount Sinai's Request
Mount Sinai Hospital requests approval from the VNA Foundation's Board of Directors for a grant of $43,600. Of this sum, $30,000 would support home health visits and other assistance to individuals who are completely uninsured. Operating support of$10,000 would defray the projected cost of free care by Mount Sinai for this group of patients so that the Hospital would spend $38,000, rather than the planned $48,000. In addition, assistance of$3,600 would underwrite .05 FTE of the Health Care Director's salary for the added burden of establishing some baseline level of data for from records of uninsured patients served last year and tracking progress toward outcome objectives this year.

VNA Facts

More than half of uninsured families earn an annual income of less than $35,000 for a family of four and private health insurance can exceed 10% of this income.

Enter your email address in the field below:

20 N. Wacker Dr., Suite 3118
Chicago, IL 60606
Phone: 312/214-1521
Fax: 312/214-1529