Leveraging Telehealth to Enhance the Patient and Clinician Experience

The following guest post is adopted from the blog of CareXM, NHPCO Strategic Partner. 

Providing exceptional care to patients while improving the clinician experience can be challenging. Goshen Health, a 3,000-employee Magnet Hospital, proved that through effective experience management, hospice programs can not only survive but even thrive during intensive situations.

Before the emergence of the COVID pandemic, Goshen Health recognized the importance of leveraging technology, restructuring processes, and focusing on its people. This approach successfully saw them through this chaotic period. Their team spearheaded an innovative approach that combined technology, a dedicated triage system, and workforce restructuring to drive positive changes. Here’s a closer look at Goshen Health’s action plan and the results they achieved within the first year:

The Action Plan

People, Processes, and Technology

Goshen Health’s journey to improve the patient and clinician experience began with a holistic approach. They recognized that success would depend on addressing multiple parts of their operations. To achieve this balance, they prioritized three key areas: people, processes, and technology.

• People are at the heart of healthcare. Goshen became dedicated to supporting both patients and clinicians throughout this growth process, leaving no one behind.
• Processes show who you are. Goshen left no stone unturned, dedicating time to transform their administrative processes throughout every part of their healthcare routines.
• Technology transforms quality of care. Goshen elevated their procedures with triage and telehealth which supported, maintained, and engaged the healthcare journey for all.

Restructure Employment

Goshen Health recognized they needed a dedicated workforce committed to their mission of quality care. They undertook a significant restructuring effort and converted part-time employees into salaried full-time equivalents (FTEs). This change created opportunities for staff, but more importantly, it led to clear productivity expectations for everyone. It not only created a stable workforce, but also allowed for greater patient engagement opportunities and accountability efforts overall.

Engage Triage Technology

One of the pivotal steps in Goshen Health’s transformation was their commitment to partnering with a provider offering a care coordination platform with business intelligence for healthcare–CareXM. This collaboration allowed Goshen to streamline after-hours triage and leverage technology to enhance patient care and clinician support. With a robust triage system in place, the hospital staff could focus on proactive case management and improving patient outcomes.

Goshen’s Results

The changes implemented within Goshen Health yielded results within just one year. These outcomes highlighted the success of their strategic approach and the positive impact on both patients and clinicians in many different aspects:

• 70% Reduction in Overtime Expenses: By optimizing their workforce, Goshen Health reduced overtime expenses. The considerate amount of savings allowed the hospital to invest in other areas that needed support. They were able to hire full-time case managers, as well as dedicated evening and weekend staff that ensured around-the-clock patient support.
• Significant Reduction in After-Hours Calls: With a streamlined triage system, Goshen Health experienced a significant decrease in after-hours calls. This allowed for proactive patient management, ensuring that each patient received timely care and support–even over the phone.
• Drastic Reduction in Call Times: Goshen found a clinician-backed and solution-based partner for telehealth services. Shorter call times translated to improved patient satisfaction overall as complaints dwindled.
• Clinician Peace of Mind: The restructuring efforts and improved triage system provided clinicians with the peace of mind needed to tackle the overwhelming number of patients. Best of all, they could “unplug” and disconnect from work, still confident that their patients were receiving quality care during non-office hours.
• Leadership in Employee Engagement: Goshen’s dedication to improving the clinician experience had a profound impact on employee engagement across the board. Their home health and hospice sector set the standard for emotional commitment, inspiring other departments to follow suit and work on behalf of Goshen’s other goals.
• Enhanced Documentation and Virtual Mentoring: Accreditation reviewers noted significant improvements in clinician documentation and virtual mentoring.

With the Right Partnership, Providers Can Overcome Any Outcome

Goshen Health’s journey to enhance the patient and clinician experience serves as an inspiring example of what can be achieved through innovation, commitment, and strategic thinking. By focusing on people, processes, technology, and a triage solution, they achieved remarkable results within a short timeframe. This success story underscores the profound impact that a patient-centered approach can have on both clinician and patient satisfaction, ultimately making healthcare a better experience for everyone involved.

Learn more about the CareXM mission to help partners effortlessly anticipate and respond to patient needs with triage technology backed by our on-demand triage team.

The Carters Are Showing Us What Hospice Means

By Ben Marcantonio, NHPCO COO and Interim CEO 

Former President Jimmy Carter and his family are showing us what it means to live fully and meaningfully at the end of life. For more than nine months, the family has generously shared parts of their experience with us, the American public, and by doing so have painted a new picture of hospice care for millions of Americans.

The photos and videos from the Rosalynn Carter memorial celebrations last week are the latest, and perhaps the most potent, examples of the Carters helping to reframe how people think about the end of life. Many people think of hospice care as giving up, or as something that is only available for a few days. The choice for hospice care has grown consistently to the point where today about half of Medicare beneficiaries select hospice for their end-of-life care. Even so, many still speak the word only in a whisper. Last week, we saw with our own eyes that hospice care can help patients achieve their most important goals even when their time to do so is limited. As New York Times reporters Rick Rojas and Jacey Fortin pointed out “Americans Glimpse Jimmy Carter’s Frailty and His Resolve,” it took incredible personal strength and fortitude, as well as the support of his family, for Jimmy Carter to travel and take part in these celebrations of his wife’s incredible life. It also took hospice care, with a team of hospice workers working with and supporting the family to help the patient – who happens to be a former President of the United States – meet his goals for the time he has left. That is exactly what hospices do, and I could not be more grateful to the Carters for showing it to their fellow Americans in real time.

Throughout last week, news apps, television screens, social media feeds, and newspapers brought us images of the oldest former President in American history celebrating the life of former First Lady Rosalynn Carter, his beloved wife of 77 years. First, at a tribute service in Atlanta – more than 150 miles away from the Carters’ home in Plains, GA – and later at the memorial service in Plains.

In some ways, the images were striking. We saw Jimmy Carter looking thin and pale, in a wheelchair, with a blanket covering his legs. His mouth was sometimes open, and his eyes – which have always been so bright – seemed sunken. We are not accustomed to seeing former US Presidents this way.

Yet in other ways, the images are very familiar, even ordinary. Rosalyn Carter famously said, “There are only four kinds of people in the world – those that have been caregivers, those that are caregivers, those who will be caregivers, and those who will need caregivers.” Many of us have personally witnessed – and often provided care for – family members, friends, or neighbors in times of declining health and frailty at the end of life. We have all been part of commemorations celebrating the life of loved ones after death, and we know how important these moments are. The images we saw of Jimmy Carter this week remind us of our own parents, grandparents, and friends. 

Jimmy Carter entered hospice care in mid-February of this year and has been receiving care at home, as the majority of American hospice patients do. It’s a fitting next chapter for the President whose administration first tested the hospice model as a national program – a test that led to the Medicare Hospice Benefit available to all Americans today.  By publicly sharing the choice for hospice, the Carters sparked a national dialogue surrounding the myths and misconceptions often associated with hospice. Since then, the news about President Carter’s life have helped demonstrate the many benefits of hospice care, which go beyond pain management. In fact, studies show that at any length of stay, hospice benefits patients, family members, and caregivers, including increased satisfaction and quality of life, improved pain control, reduced physical and emotional distress, and reduced prolonged grief and other emotional distress.

In the nearly 300 days since President Carter first elected hospice, the family has continued to share glimpses of the former President’s day-to-day life. We know he has had opportunities to visit and pray with family and friends, and has continued to follow world news, as well as his favorite baseball team, the Atlanta Braves. We know he has enjoyed peanut butter ice cream, one of his favorite treats, and that he and Rosalynn saw Fourth of July fireworks. When President Carter celebrated his 99^th birthday on October 1, we learned that he enjoyed receiving well-wishes from everyday citizens and celebrities alike. We know that Jimmy and Rosalynn spent most of their time together, often sitting in their living room holding hands. Hospice care is designed to support exactly these types of activities and experiences. Hospice care teams work with patients to understand their goals and provide care that enables them to meet those goals to the best of their abilities.

We also know that Rosalynn Carter, a preeminent mental health advocate, was living with dementia. The family made that announcement in May. In mid-November, the family shared the news that Rosalynn Carter had also entered hospice care. She died two days later, at home.

By offering these important details – big and small – the Carters have graciously let the public into their lives. They have sparked untold numbers of conversations across the country about how we each want to live our own lives at the end, about hospice and other care options – what these choices mean, and how they align to our values. In the news, on social media, and at kitchen tables across the country, the Carters’ unfolding story has created opportunities for people to educate themselves and each other, to have courageous conversations with loved ones about their own values and how they would want to live those values if they face serious illness or death, and even to reframe what dying means – it can, and often does, mean ice cream, baseball, fireworks, and quietly holding hands with the people we love.

Adapting Palliative Care to New Models - What's in a Name?

The following guest post is adopted from the blog of Acclivity Health Solutions, NHPCO Strategic Partner. 

Written by: Robin Stawasz, Program Development Executive 

When is palliative care not palliative care? How vital is nomenclature? As the healthcare continuum and payment reform evolves, palliative care providers must re-evaluate what constitutes the essence of palliative care and how the care model can best adapt. Without a federal benefit currently defining palliative care, as it does for hospice, there is great variation in care models which causes many disadvantages. However, it also creates opportunities. Providers can hold on to the core of palliative care while specializing the services to best meet the needs of their stakeholders, including their patients, families, partnered providers, and payers.

The Guiding an Improved Dementia Experience (GUIDE) Model from CMMI is one such opportunity. GUIDE is not technically palliative care. But it calls for many of the core services that palliative care provides. Specifically, it calls for meeting the holistic needs of the patient through an interdisciplinary team, providing education and respite for the caregivers, keeping the loci of care in the home, aiding in transitions, being available 24/7, and addressing social, behavioral, and functional needs through community support. Who better than palliative care providers to deliver such services? Given the payment structure, providers will need to adapt to keep services efficient and sustainable, such as adopting technology and data capabilities to manage this population effectively. But it will create continuity of care for this seriously ill population, as well as build the relevance and networking opportunities for provider organizations. Whether palliative care providers enroll in GUIDE directly or through contracts with other GUIDE providers, there is opportunity here to build service lines, diversify revenue streams, and build costumer pipelines. Being able to apply the strengths of palliative care to new care models, no matter how they are labeled, will empower providers to take advantage of new payment models, especially within value-based care. The palliative care field needs to move into innovation, adaptation, specialization, and collaboration. If not palliative care, other providers will move into this space and the opportunity will be lost.

Interpersonal Skills Crucial to Nurse Retention and Cultural Competency

The following guest post from Enclara Pharmacia is adapted from their recent ebook, Cultivating Care: Prioritizing Hospice Nurse Learning and Development, which is available as a free download on the Enclara website. 

Two of the top priorities for hospice providers today are improving nurse retention and advancing health equity. While these are both complicated issues that call for a variety of interventions, there is at least one area where they intersect: interpersonal communication.

Perhaps because nursing is a “caring profession,” we tend to assume interpersonal communication comes naturally to nurses. However, research suggests that nurses are more or less in line with the general public when it comes to overall emotional intelligence, including social skills.

Hospice nurses are well aware that they have room for improvement. In a 2019 survey, 70 percent desired more communication training. Self-perceived deficits in navigating difficult topics with patients and caregivers were associated with stress and burnout, which can in turn increase staff turnover.

Interestingly, two of the communication areas palliative nurses find most difficult are directly related to cultural competency: talking with patients or families from different cultures and responding to spiritual concerns. This suggests that incorporating interpersonal communication training alongside diversity and inclusion initiatives can improve the nurse experience while also reducing disparities in care for minority communities with historically lower hospice participation.

For more insights, download Cultivating Care: Prioritizing Hospice Nurse Learning and Development.

• Explore the benefits of nurse education for both quality of care and staff retention
• Prioritize subject matter in technical, operational, interpersonal and clinical domains
• Leverage resources you may already have available to provide maximum value

Using Data to Manage the Hospice Cap

Janice Mitchell, Communications Specialist at Axxess

Hospice leaders are responsible for the health and well-being of both their patients and their organization. From a financial perspective, this includes minimizing risk by managing spending and the hospice cap.

Defining the Hospice Cap

The cap is designed to ensure that hospice care does not exceed the cost of conventional medical care at the end of life. The allowable amounts are limited by two things: an annual limit per beneficiary and the number of beneficiaries served. Any amount paid to a hospice for its claims that exceeds the cap is considered an overpayment and must be repaid to Medicare.

The fiscal year 2023 hospice cap amount increased by 3.8% from the prior year. The recommendation from the June 2023 MedPAC report is for Congress to update the Medicare base payment rates by the amount specified in current law with a wage adjustment, in addition to reducing the hospice aggregate cap by 20%.

Minimize the Risk of Overpayment

“I was thinking specifically about the Medicare payment and cap rate, and [these are] some of my favorite hospice solution features that I wish I would have had as an operator to minimize my risk – outside of spiral bound notebooks,” said Christina Andrews, Senior Director of Professional Services at Axxess.

Reports on the topics outlined below can help organizations minimize their risk of overpayment:

•  Cap Statistics Report: This type of report calculates allowable Medicare payments, estimates how much revenue is under or over the cap, estimates Medicare beneficiaries and provides the total number of Medicare inpatient days and the maximum inpatient days.
• Median and Average Length of Stay Reports: These reports generate the median and average length of stay for the specified date range. This information helps organizations determine if there is an opportunity to create a balanced length of stay.
• Referral Report: This type of report generates a list of all patients and referrals entered into the system, which also helps balance the length of stay.

How to Balance Length of Stay

Andrews encourages hospice organizations to develop a strategy to balance the average length of stay for their patients. Hospices above the cap admit fewer patients per year and have significantly longer stays and higher discharge rates than hospices below the cap. The following activities can be included in the plan.

• Have daily cap calls to report on daily activity toward goals.
• Assess community needs on an ongoing basis to grow market share and penetration.
• Create a brand and identify key messages to convey based on community needs and how your organization solves them.
• Develop marketing and sales strategies based on referral and admission data.
• Establish weekly admission goals by referral partner.
• Use needs-based selling that highlights the value proposition of the services provided.
• Create a diversification strategy to impact the referral mix and stay within national benchmarks.

Using Business Intelligence

Andrews also recommends the use of business intelligence dashboards to create a road map to success. Useful key performance indicators include:

• Medicare Beneficiaries
• Average Length of Stay
• Media Length of Stay
• Referrals by Referral Partner
• Inpatient Days as a Percentage of Total
• Admissions by Benefit Period
• Admissions by Primary Diagnosis
• Live Discharges by Reason
• Benchmark Against Self
• Benchmark Against National

“Be very cautious of information overload,” Andrews said. “This is the excess of information available to a person aiming to complete a task or make a choice. Managing cap risk is a daily task driven by strategy and the metrics that matter.”

Axxess Hospice, a cloud-based hospice software, includes tools such as intuitive medication management and real-time plan of care updates as outlined above to help keep organizations compliant.

Disclaimer: Axxess is a 2023 Strategic Partner of NHPCO. All views expressed in this blog are the author’s own and do not represent the view of NHPCO.

Life, Liberty, and the Pursuit of Equitable Access to Healthcare for All

 

By Ben Marcantonio

COO and interim CEO of the National Hospice and Palliative Care Organization (NHPCO)

The Fourth of July is a time to celebrate the United States’ independence, but it is also an opportunity to reflect on our nation’s founding principles, and how we can live by those ideals today and into the future. The Declaration of Independence tells us: “We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.” The first sentence of the U.S. Constitution sets out the purpose of that founding document and our purpose as a country: “We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America.”

As I think about our work in hospice and palliative care, and the broader healthcare community, I see our purpose reflected in these founding documents. Providers certainly are foundational to quality of life and the pursuit of happiness. By supporting patients, families, and the community, we are helping form a more perfect union. Delivering equitable access to healthcare for all is an important part of justice.

Last week, the news was dominated by headlines about recent Supreme Court decisions on affirmative action and LGBTQ+ rights. Regardless of whether you think the court made the right or wrong decisions in these cases, we can all recognize that these rulings will affect the everyday lives of people, particularly Black and Hispanic individuals, and members of the LGBTQ+ community. We also know that these decisions have an influence that is broader and deeper than meets the eye.

These court decisions have multi-directional impact because they are connected to healthcare. Every day, in communities across America, there are people who have inequitable access to healthcare. It’s clear that access to care is impacted by factors such as wealth, where people live, and what insurance they have or are lacking. It may be less obvious on the surface, but it is no less true that race, ethnicity, language, gender, sexual orientation, and religion can impact access to and/or delivery of care as well. If you can’t get care in a language you understand, is that full access to care? If treatment of pain is likely to vary based on a patient’s race, is our health system equitable? If our Hispanic and Latino neighbors know less about hospice than their Black or White counterparts, as shown in a recent report, can we say we are delivering on the promise of equal access? These issues are often compounded by lack of trust and dedicating the time it takes to build rapport and meaningful relationships. The Hospice through the DEI Lens report shows that nearly 1/3 of LGBTQ+ respondents either doubt or are unsure that hospice care providers would respect their sexuality. With that level of doubt, LGBTQ+ people are less likely to access care. Decades of mistreatment of African American/Black and Native American communities by the medical establishment has led to mistrust of doctors and health facilities, creating significant barriers to access for many Americans today. 

As a longtime hospice provider, and now a champion for hospices across the country, I am proud of the many ways in which our members have been at the forefront of making care accessible to more people. One of the most prominent examples is the way that hospices stepped up during the AIDS crisis to care for patients who were largely ignored by the rest of the health system. Today, we have incredible and inspiring examples of hospices reaching people where they are. There are hospices in prisons, with care provided by prisoners. There are hospices delivering care to people who are unhoused. There are hospices established recently with the express goal of reaching underserved communities, in both rural and urban settings, as well as hospices focused on connecting with African American and Black communities. Let’s take that further. Our charge to support equitable and accessible care for ALL at the end of life, includes caring for those who are on the unpredictable and often precarious trajectory of serious illness and co-morbid conditions.

This imperative and unwavering commitment to equity and justice is foundational to our country and to the hospice movement and should be our guide to creating a better future for all. But equity does not exist in a vacuum. It is found through embracing diversity of thought, words, and actions as well as a curiosity for learning with an open mind. As our nation continues to wrestle with inequities that prevent certain groups of people from pursing life, liberty, and happiness, we can strive for an even more perfect union to become a part of the solution. I believe the hospice and palliative care community has an important role to play. It’s our job to meet people where they are, to provide the care they need at the right time and in the right manner. Our job as healthcare providers is to recognize and celebrate the differences that make each person unique, and to deliver care that meets their individual needs. I’m proud to be part of this community; I’m proud of NHPCO’s work to support hospices in advancing equity and providing inclusive care; I’m proud that the hospice movement is helping advance freedom and justice. As we look to the future of our country and of the hospice movement, we must remain committed to freedom, justice, and equality for all.

Note: NHPCO offers a wealth of hospice and palliative care access and inclusion resources at www.nhpco.org/diversity

Hospice Action Week 2023: Advocates Unite on Capitol Hill

On Wednesday, June 7 hospice and palliative care advocates from across the nation made a difference and presented a united voice in Washington, DC.

As a part of the annual Hospice Action Hill Day, over 70 NHPCO and HAN advocates gathered to make legislative visits on Capitol Hill in support of key policy priorities impacting hospices of all shapes and sizes. This was the first completely in-person Hospice Action Hill Day since 2020. Participants were excited to come together and have face-to-face congressional meetings for the first time in years.

Participants included members of the board of directors for both organizations, state leaders, MyHospice Ambassadors, and grassroots advocates. There were representatives from every piece of the hospice and palliative care system, from CEOs to clinicians and nurses, from administrators to volunteers. NHPCO and HAN staff also joined groups of advocates for meetings, including five NHPCO summer interns. Advocates’ previous experience on the Hill ranged from decades of visits to the Capitol to this event being their first-ever opportunity to meet with legislators.

Over 130 Congressional offices in the House and Senate took time to speak with advocates representing providers, patients, and families from more than half the total states in the US.

Advocates spoke with legislative offices about five key policy issues: community-based palliative care, program integrity, payment policy, the future of the hospice workforce, and the results of the recent NORC study on annual hospice cost savings to Medicare. Through a series of trainings and resources, advocates were introduced to recent developments on these issues and key asks for legislators.

One key ask was for legislators to support the Expanding Access to Palliative Cart Act (S. 1845), which was introduced on June 7 during Hospice Action Hill Day. This bill would authorize the Centers for Medicare & Medicaid Services (CMS) to test a demonstration model of providing palliative care to Medicare beneficiaries outside of the hospice benefit and in community settings. On the workforce front, legislative offices were also asked to support the Palliative Care and Hospice Education and Training Act (PCHETA), which is expected to be reintroduced before the end of June.

On program integrity asks, advocates informed legislative offices of NHPCO and partners’ 34 recommendations to CMS, and that a bipartisan sign-on letter to CMS on the issue from Representatives Earl Blumenauer (OR) and Beth Van Duyne (TX) would soon be circulating.

Advocates have shared that legislative offices were engaged with policy issues and asks, expressing enthusiasm for the latest NORC research, interest in exploring paths forward for workforce and program integrity issues, and in expanding access to palliative care. Offices also reportedly expressed interest in being involved in the We Honor Veterans program.

At the pre-Hill Day training on June 6, Hill staffer Sarah Gilbert of Representative Neal Dunn’s office (R-FL) stopped by for a conversation about what advocates could expect when meeting with a Congressional office. 

The training also included recognition for leaders and advocates who made a special difference in the last year for hospice and palliative care.

The 2022 Hospice Angel Awards for members of Congress were shared. Advocates meeting with some offices the following day were able to personally deliver these awards. Honorees who met with advocates during the Hospice Action Hill Day included Senator Shelley Capito (R-WV) and Congressman Joe Morelle (D-NY).

Winners of the 2022 MyHospice Ambassador Awards were also formally announced at the pre-Hill Day event. MyHospice Ambassadors is an advocacy program for those who are particularly committed to advancing hospice and palliative care through their demonstrated passion, dedication, and leadership. These award winners stood out through their efforts in the previous year:

• Rookie of the Year: Angela LaBarca, Business Development Specialist with Caring Circle Hospice, Michigan
• Impactful Voice: Sandy Kuhlman, Executive Director of Hospice Services of Northwest Kansas, Inc., Kansas
• Ambassador of the Year: Demetress Harrell, CEO of Hospice in the Pines, Texas

The event also briefly recognized Mackenzie Daniek, co-director of Providence Hospice in Seattle and first-time Hospice Action Hill Day attendee. Daniek co-wrote an impactful op-ed on hospice care in the Seattle Times this past April, and organizers wanted to recognize the piece as an ideal example of advocates effectively raising the profile of hospice and palliative care issues.

Overall, the Hospice Action Hill Day and the training that preceded it have already proven to be a seminal moment in NHPCO and HAN advocacy for 2023. With the start of a new Congress and the resolution of outstanding issues like the debt ceiling, it was vital for hospice and palliative care advocates to come together and raise a collective voice for the cause. After years of being separate-but-together, an in-person advocacy event provided opportunities for renewed energy among advocates from across the country.

Learn more about how YOU can be part of changing hospice care policy for the better by signing up with the Hospice Action Network today!

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