One of the challenges for
hospice and palliative leaders has always been that their services were seen as
a small part of the healthcare continuum. Over and over, I’ve had hospice CEOs
and administrators tell me their greatest frustration was getting the time of
day from hospital and health system execs.
Lately, however, I’m not hearing
that as much. Instead, I hear clients and friends telling me their local system
seems interested in post-acute care in a new way. In January of this year, the
Society for Healthcare Strategy & Market Development published results from
a survey of hospital and health system executives, CEOs and CFOs, mostly. They
were asked, “How likely is it that by 2021, the proportion of your hospital or
health system’s expenditures devoted to post-acute care capabilities
(palliative care, hospice, or skilled nursing) will increase?” Fully 92% of
them said it was Likely. 54% of them even said “Very Likely.”
The reason for this new
attention to post-acute care is that new payment incentives are strongly
encouraging acute care providers to care about what happens after patients are
discharged from the hospital more than ever before. This hasn’t always been the
case. Jeff Goldsmith, the well-known healthcare futurist, recently wrote about
this issue: “Traditionally, the hospital’s responsibility ended abruptly upon
discharge. In candor, the discharge process often was not focused on patient
outcomes. In many institutions, the main focus was on clearing the bed and
making sure the patient had a safe ride home.”
Now however, inattention to what
happens immediately after an acute care episode can cost the hospital, health
system or ACO money. If the patient comes back as a re-admission or Emergency
Department visitor, that’s bad, not only for the patient, but also for the
at-risk provider’s bottom line.
Cost avoidance is the name of
the game, and post-acute care is finally getting its due as a key component in
improving outcomes and reducing costs. Unfortunately, that doesn’t always mean
that the hospital CEOs know clearly what they want or need from hospice. Nor
does it mean they always have a good understanding of why hospices can make
vital partners in a health system’s efforts to reduce costs of care.
Hospice leaders may find
themselves in the position of (gently) helping their local hospitals and health
systems to understand the new imperatives of managing costs when revenue is at
risk. After all, managing patient costs on a fixed payment is something that
the hospice industry has been doing since 1983.
This post is a preview from a longer article on working with ACOs and
hospitals that will appear in the Summer edition of NHPCO’s Newsline out June
15.
Sue Lyn Schramm, MA
Director, Consulting Services, NHPCO
