National Hospice and Palliative Care Organizations Palliative Care

National � Hospice and Palliative Care Organization’s Palliative Care Resource Series Hospice-Hospital Collaborations: Making the Case to Hospital Administrators Todd Cote, MD

Objectives • R �eview the current hospital environment and types of hospicehospital collaborations. • Discuss benefits, barriers and challenges of hospice-hospital collaborations. • Present strategies to build a case to hospital administrators.

Current Hospital Environment • • �ocused on internal and external quality improvement F Interested in value added programs (Value=Quality/Cost) Data-driven Government mandates from health care reform: – Readmission rates – Mortality index (observed deaths/expected deaths) – Patient satisfaction ratings

Types of Collaboration Independent Contracts with Hospitals • Medicare Hospice benefit (MHB) Hospice General Inpatient Care (GIP) • Hospice liaison nurse/ hospice inpatient team

Types of Collaboration Extensive contracts • Hospice program within/or part of a hospital organization or hospital system: – – Inpatient hospice and/or palliative care units Small scale comfort suites Palliative care consultation teams Hospice may be subsidiary company under hospital system

Types of Collaboration Contracts to Support End-of-Life Services • EOL education programs • Ethics committee membership • Palliative care coordinating committee • Case management • Advance directive programs

Benefits of Collaboration Hospice • Increase access to more patients • Learn about hospital care • Timely referrals

Benefits of Collaboration Hospital • Improve quality of EOL care • Learn about hospice • Improve continuity of care • Improve branding and patient satisfaction

Barriers and Challenges Legal, Regulatory and Financial • Conditions of Participation: acute care hospital versus hospice(level of care/benefit periods/eligibility/relatedness) • The OIG and ‘Others” • Certificate of Need • Hospice competition • Budgetary restraints • Varying payment schemes

Barriers and Challenges Systemic Process • Electronic medical record • Documentation requirements, workforce after hour call, clinician credentialing • Bed management logistics • Transitioning patients out of hospital to hospice

Barriers and Challenges Institutional Culture • Quality of end-of-life care in hospitals is slow to improve • Denial of death • Lack of education

Making a Case to Hospital Administrators • True Partnerships • Respect and understanding from each organization and their leaders • Hospice and hospital champions • Outstanding clinical leadership

Know Your Hospital and Hospital Administrator When you’ve seen one hospital, you’ve seen one hospital! • Understand overall mission and vision • Research the administrator – background, experience with hospice, etc. • Assume nothing! Fully explain hospice the MHB and the Co. Ps

Know What the Hospital Needs • Ask administrators! • Understand government mandates – hospital re-admissions, mortality index, patient satisfaction scoring • Address end-of-life care within the hospital • Gather data showing how hospices are servicing hospitals – national, Medicare data-mining and private firms.

Examples: Evidence Based Data • Palliative Care Services in the hospital can reduce hospital cost. (Prevent unnecessary inpatient utilization: ↓ LOS, ↓ Ancillary charges). • Post-hospitalized patients referred to hospice have lower readmission rates. • Re-hospitalization care of hospice patients is costly to the hospital. • Education and comfort care order sets improve end of life care for patients dying in a hospital. • Hospice can improve patient/family satisfaction.

Know What the Hospice Can Do • • �imited hospice budget L Expert level workforce Consideration for 24/7 services and on-call Hospice competition – healthy vs unhealthy

Conclusion • H �ospice–Hospital collaborations are important for the future of end-of-life care and can be a win-win for both organizations. • Collaboration involves proper planning, knowledge and leadership. • Financial sustainability is feasible but requires a true partnership based on mutual respect and support.