Using Metrics for Marketing

If I could offer one key to getting your foot in the door with potential partners and referral sources, it would be, “know your metrics.” Don’t just tell the local health system that you provide great hospice care and your patients love you. Tell them that you can prevent those patients from bouncing back into the hospital or ER. And then prove it.  

You can use your own patients’ histories to make the case. Gather aggregate statistics on your patients’ hospital admissions or ED visits in the period prior to hospice admission. You may cover the 30, 60 or 90 days prior to the hospice admit; then look at their care patterns afterwards. Be sure you know what percentage of your hospice patients are admitted to a hospital while on service and break it out by diagnosis, so you look closely at those diagnoses that we know are highly likely to run the risk of readmission. In particular, check hospital utilization for patients admitted to hospice after hospital admissions for COPD, CHF or stroke. 

One key measure that will pique the interest of ACO referral sources is the overall cost of care for your patients. ACO shared savings targets depend on reducing the total cost of care for the lives assigned to the ACO, regardless of where that care is received. If you can demonstrate a mean Medicare payment per admission that’s lower than your competitors, you might consider sharing that information with the leadership of the ACO with whom you seek preferred status. You may be able to get that comparative data from your state survey of hospices, or from one of the national hospice data analytics firms that gathers Medicare claims. 

Consider external sources of data as well. If your relationship with the local health system permits, you may be able to run a cooperative study, drawing from their inpatient data to find out which diagnoses and which patients are creating avoidable costs to the system. And don’t forget to check the CMS consumer site, Hospital Compare. That site shows rates of readmission for several key diagnoses, and how well each individual hospital is doing at meeting targets for avoidable readmits. 

Be imaginative and try to see through the lens of your referral partners’ needs. If hospice and palliative providers are truly to take a seat at the table, we need be seen as the problem solvers we are.

Sue Lyn Schramm, MA
Director, Consulting Services, NHPCO

See the previous NHPCO Edge Blog article, "The Gentle Art of Teaching Hospital CEOs."

 

The Gentle Art of Teaching Hospital CEOs

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

New Strategic Opportunities for Hospice

On Tuesday, March 8, Medicare announced a new five-year initiative that has the potential to radically change the way it pays for outpatient drugs. This is just another part of CMS’ ongoing migration of provider incentives from volume to value. These changes are already altering the landscape for hospices and their relationships with professional referral sources, including hospitals, health systems, physicians and ACOs.

Healthcare payment reform is creating a new set of challenges and opportunities for hospitals and health systems. This seminar will help the hospice administrator evaluate opportunities to become an active partner with hospitals, Accountable Care Organizations (ACOs) and other at-risk organizations in your market. In this session, you’ll gain clarity and a sense of direction for your organization’s strategies by learning from the perspective of three speakers: a hospice strategist, a hospice provider, and an ACO physician and owner.

Are you comfortable that you understand all the implications for your hospice?

In April, at the NHPCO Management and Leadership Conference, Sue Lyn Schramm, M.A., Director of NHPCO Edge, will be leading a half-day preconference session on the topic of hospice strategies for working with ACOs. Taking Hospice Skills Upstream: New Ways Hospice Can Partner with Health Systems and ACO’s is being presented on Wednesday, April 20, 9:00am - 12:00pm and online registration is open until March 31, 2016.

Of additional interest, attendees may want to consider combining attendance at this cutting-edge preconference session with the 2^nd Annual Executive Business Summit, Beyond the Benefit: Delivering on the triple aim in healthcare through palliative care, happening April 20 from 5:00 - 6:00pm (separate registration is required.)

Sue Lynn Schramm, MA
NHPCO Director, Consulting Services

See Sue Lyn Schramm's article in Spring 2016 NewsLine on ACOs and Alternative Payment Models.

Dartmouth Atlas Report

US End-of-Life Care Changing: While Medicare Patients are Spending Less Time in Hospital, Those Admitted Receive More Intensive Care

Chronically ill Medicare patients spent fewer days in the hospital and received more hospice care in 2007 than they did in 2003, but at the same time there was an increase in the intensity of care for patients who were hospitalized, according to the Dartmouth Atlas Project report "Trends and Variation in End-of-Life Care for Medicare Beneficiaries with Severe Chronic Illness."

"It may be possible to reduce spending, while also improving the quality of care, by ensuring that patient preferences are more closely followed," said David C. Goodman, M.D., M.S., lead author and co-principal investigator.

Download the full report in PDF from Dartmouth Atlas website.

Researchers Find that Cancer Patients who Disenroll from Hospice have Increased Hospitalizations and are less likely to Die at Home

Disenrollment can have a Physical and Financial Toll

(Alexandria, Va) – According to a new study, patients with terminal cancer that disenrolled from hospice care had significantly higher rates of hospitalizations – including admission to the emergency department and intensive care unit – than patients who remained under the care of hospice. Furthermore, patients who disenrolled from hospice were more likely to die in the hospital than patients who remained with hospice until their deaths.

National Hospice and Palliative Care Organization hopes that healthcare professionals and policy makers will take time to look at this and other recent studies that help provide a better understanding of both the cost and quality-of-life benefits associated with the hospice experience, including honoring a patient’s wish to be able to die at home.

The study, which was led by researchers at the Mount Sinai School of Medicine, found that:

• 33.9 percent of the patients who disenrolled from hospice care were admitted to an emergency department, in contrast with only 3.1 percent of hospice patients.
• 39.8 percent of disenrolled patients were admitted to the hospital as an inpatient, in contrast with only 1.6 percent of hospice patients.
• Disenrolled patients spent an average of 19.3 days in the hospital, whereas hospice patients spent an average of 6.7 days.
• 9.6 percent of disenrolled patients died in the hospital, compared to only 0.2 percent of hospice patients.
• Costs of care for patients with cancer who disenrolled from hospice were nearly five times higher than for patients who remained with hospice.

“Impact of Hospice Disenrollment on Healthcare Use and Medical Expenditures for Patients with Cancer” is published in the October 1, 2010 issue of Journal of Clinical Oncology.

“This study illustrates the tangible value of hospice care to patients who want to die at home, with the support of the hospice interdisciplinary team, surrounded by family rather than in a hospital connected to machines. There are significant emotional and financial benefits to the patient, family and healthcare system when hospices are caring for people,” said J. Donald Schumacher, NHPCO president and CEO. “In my 30 years running a hospice, I heard time and time again from families that wanted to keep their dying loved one at home.”

“There are numerous reasons why a patient may disenroll from hospice, and while those factors were not part of this study, we are reminded of the importance of advising patients and families as to the potential toll that might accompany leaving hospice care prematurely. A toll that may be physical, emotional, and financial,” added Schumacher.

Wrote the study authors, “Policy makers have called for tightening eligibility restrictions for the MHB (Medicare Hospice Benefit) as part of a wider effort to reduce high Medicare expenditures; our results suggest that addressing hospice disenrollment may be an effective means of reducing Medicare expenditures for hospice users without restriction access to the MHB.”

Further recommendations suggest that oncologists explore outpatient palliative care services that offer multidisciplinary care, symptom control, and end-of-life planning expertise in a context that enables a patient and family to maintain contact with the oncology clinic.

In his plenary address at NHPCO’s “Developing the Continuum of Care” conference held in Boston on August 5, Dr. Schumacher encouraged all hospice providers to explore ways that they can offer “pre-hospice” palliative care services in their communities and work with other providers to ensure patients and families have the right care at the right time from diagnosis on through bereavement for family.

More than 1.5 million patients with life-limiting illness receive care every year from the nation’s hospices.

Information about hospice and advance care planning is available from NHPCO’s Caring Connections. Visit caringinfo.org or call the HelpLine at 1-800-658-8898.

NHF Donates $15,000 for Haitian Earthquake Relief

$15,000 for Haitian Earthquake Relief

Usings funds from our Disaster Relief Fund, we were able to donate an initial $15,000 to Haitian earthquake relief. Three organizations doing on-the-ground work in Haiti have each received $5,000: Holy Angels Hospice, Partners in Health, and the Hôpital Albert Schweitzer (Albert Schweitzer Hospital). We invite you to donate directly to these organizatons or make a contribution to NHF's Disaster Relief Fund.

Just like everybody who has been watching the heartbreaking images from Haiti, NHF’s board and staff have reacted with horror and sadness to the tragedy unfolding in that nation,” said J. Donald Schumacher, President & CEO. “We were so grateful that past donations to the NHF Disaster Relief Fund allowed us to respond quickly with cash to these three fine organizations. It feels good to know we are doing something tangible to help in the wake of such devastation.”

Holy Angels Hospice & Orphanage is located in Port-au-Prince. Although much of the capital city has been destroyed, their facility is still standing. Holy Angels is in dire need of financial resources to ramp up service provision. Prior to the earthquake, they focused exclusively on caring for children. With the enormous need created by the earthquake, Holy Angels plans to expand their services.

Partners in Health (PIH) is a Boston-based international health agency that has been working in Haiti for more than 20 years. PIH works to bring modern medical care to poor communities in nine countries around the world. The work of PIH has three goals: to care for patients, to alleviate the root causes of disease in their communities, and to share lessons learned around the world. Right now in Haiti, one of PIH’s main goals is to help with pain relief. PIH has deep roots and a major presence in Haiti, particularly in the Central Plateau region that sits northeast of Port-au-Prince.

The Hôpital Albert Schweitzer (HAS) is located 42 miles outside of Port-au-Prince and escaped damage, although buildings even further away from the capital city were destroyed. According to the hospital director, the 120-bed hospital went over capacity within minutes following the earthquake and the staff of 200 immediately shifted into a mass casualty protocol. With so many of the injured arriving with broken or crushed bones, the x-ray machines and operating rooms are in constant use.

Knowing that the need for assistance is both immediate and long-term, NHF will monitor the situation in Haiti and make additional donations during the long period of rebuilding.