Guest Columns

Making inroads with hospitals and hospice

Lisa Abicht-Swensen, M.H.A.
Lisa Abicht-Swensen, M.H.A.

More individuals are dying of chronic progressive diseases that require longer and more sustained care. An increasing number of these individuals reside in skilled nursing facilities prior to their death. It is projected that by 2030, half of the 3 million persons projected to be in a nursing home will die there.

Hospice and skilled nursing facilities partnering together in care and service to dying residents is not new. What is new is the dramatically changing landscape in the era of healthcare reform, which has organizations vying for position as strategic partners. Post-acute care providers, who fail to move beyond the confines of historic practice and partnership behaviors, will most definitely be left behind.

Hospice programs and SNFs must immediately implement a strategy to develop and market a strong, strategic nursing home/hospice partnership with hospitals, ACOs, MCOs, etc. These entities represent the “new buyers” of our services. So, we need to present an impressive force in terms of our ability to decrease costs, positively impact re-hospitalization rates and increase quality of life for those we serve.

By developing a well-researched, organized approach — using data to support quality and efficiency of care —nursing home/hospice partners can quickly convince these “new buyers” of the necessity for inclusion in their network of providers.

Benefits to hospitals, ACOs, MCOs

Earlier patient discharges to nursing homes with hospice services lowers mortality rates and shortens LOS in the hospital setting.

The nursing home/hospice partnership prevents hospital re-admissions. Hospice supports the nursing home in providing expert medical care, pain management and additional emotional/spiritual support, thus maintaining the patient's comfort and eliminating the need for re-admission to the hospital setting.

Anecdotal evidence has long supported the notion that quality of life is enhanced when hospice is involved, resulting in very high levels of patient and family satisfaction.

Terminally ill patients are expensive. Hospice has long demonstrated the cost savings for using hospice, in lieu of curative care.

Hospice/nursing home partnerships working together can effectively influence more utilization of hospice services, thus creating cost savings to the hospital, ACO or MCO.

Leadership considerations

What do you need to do for your hospice unit to partner with a hospital? 

1. Request and secure a presentation to the hospital, ACO, MCO, etc.
  • Engage in a dialogue.
  • Discuss the specific hospital, ACO, MCO setting and their issues.
  • Strive to make your presentation memorable and different. (Chances are you won't be the only hospice presenting to them.)
  • Acknowledge any expressed concerns and their validity.

2. BEFORE YOUR PRESENTATION, research and gather data from the hospital you wish to partner with, from sources such as Hospital Compare, state Department of Health and hospital association.

 

  • Research 30-day, risk-adjusted mortality rates for patients admitted to the hospital with AMI, CHF, COPD, and pneumonia.
  • Research patients dying at rates greater than the norm.
  • Research LOS longer than the norm.
  • Calculate the benefit in earlier discharge to hospice, in terms of lower mortality rate and shorter LOS.
  • Calculate the benefit in eliminating re-admissions for this population of patients, who typically have high re-admission rates.

3. Utilize the gathered data to advocate for hospice, as one of the needed solutions.

In a hospital setting:

  • Explain how hospice prevents readmissions.
  • Develop a POA to identify terminally ill CHF and COPD patients, in collaboration with the hospital.
  • Set up policies, procedures and protocols regarding these patients.
  • Offer to in-service cardiac unit physicians and nurses on terminal criteria.
  • Commit to being available for an initial hospice consult, within a given timeframe.

Within the ACO:

  • Demonstrate the cost savings for using hospice, in lieu of curative care. (There are several evidence-based studies in the literature.)
  • Request names of specialists and primary care physicians, who are part of the ACO, to determine who is under utilizing hospice. Make joint calls with ACO representatives to educate physicians about hospice.
  • Request ACO support to work with their network of home health agencies, to jointly identify terminally ill Medicare patients.
  • Request real-time access to ACO patient management databases, to monitor for terminally ill patients.

Within a bundled payment strategy:

  • For post-discharge services, focus on the hospice's value — eliminating costly, unnecessary hospitalizations.
  • Identify specific patient populations, where hospice is being under utilized. Provide literature review for support.

Within MCOs:

  • Offer to assist the MCO in getting their members to establish health care directives.
  • Agree to educate health and transition coaches on the benefits of hospice.
  • Propose a concurrent care pilot with the MCO, to allow members to “try” hospice before committing, while still receiving curative care. 
  • Provide articles on the success of concurrent care to make your case.
  • Determine if the MCO has “complex case management” capability and understands their scope.
  • Discuss a financially viable concurrent care service package.
  • Express the goal as a break-even plan for pre-hospice election.

Successful, collaborative partnerships between SNFs and hospice providers represent an important and powerful presence in post-acute care. Together their efforts in service delivery ultimately result in cost savings, decreased re-hospitalizations and, perhaps more importantly in terms of care, more terminally ill people experiencing quality, compassionate care at the end of life.

Lisa Abicht-Swensen, M.H.A., is the director of home care and hospice at Pathway Health.



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