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Hospice-Hospital Collaborations: Making the Case to Hospital Administrators

This resource series explores the current hospital environment and the benefits, barriers, and challenges of hospice-hospital collaborations. It presents strategies to build a case to hospital administrators for implementing these collaborations.

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Hospice-Hospital Collaborations: Making the Case to Hospital Administrators

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  1. National Hospice and Palliative Care Organization’sPalliative Care Resource SeriesHospice-Hospital Collaborations:Making the Case to Hospital AdministratorsTodd Cote, MD

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

  3. Current Hospital Environment • Focused on internal and external quality improvement • 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

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

  5. 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

  6. 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

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

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

  9. 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

  10. 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

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

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

  13. 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 CoPs

  14. 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.

  15. 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 re-admission 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.

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

  17. Conclusion • Hospice–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.

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