Hospice: Life s Final Journey Are You Ready? Anthony D Antonio Senior Director, Business Development Sodexo Senior Living Agenda I. Government Scrutiny and Hospice II. III. IV. What is Hospice? NHPCO Facts and Figures Expectations of Your Hospice Provider V. Marketing Techniques of Hospice Representatives VI. Contracting for Success VII. Solutions and Resources 1
I. Government Scrutiny and Hospice I. Government Scrutiny and Hospice How many of you have had experience using hospice? Was your experience positive or negative? Why? 2
I. Government Scrutiny and Hospice Diagnoses requiring less complex care Paid ~$1,100/week per beneficiary 2012 Medicare payments = $2.1 billion Provided fewer than 5 hours of visits I. Government Scrutiny and Hospice Defending False Claims Act Medical Necessity Cases Bring and Rissler Article The Real Story Behind the Latest Hospice Controversy Washington Post, January 3, 2014 Medicare s Hospice Payment Plan Fosters Abuse The Medicare Newsgroup, February 27, 2015 Increased Scrutiny Leading to Multi-Million Dollar Penalties Reinhart, August 20, 2014 Lawsuit Accuses Company of Fraudulently Cycling Patients Kaiser Health News, January 4, 2012 3
I. Government Scrutiny and Hospice LEVELS AND COST HOSPICE MEDICARE-FUNDED AVERAGE PROVIDERS LENGTH EXPENDITURES PROVIDERS HOSPICE OF BENEFICIARIES 2012 STAY Routine Care $146/day $2.9 534,213 48 2,255 billion days 672 Inpatient Care $652/day Continuous Care $853/day $15.1 1,274,000 1,198 88 3,720 days billion 10/28/11 2000 For-Profit through Non-Profit 12/31/11 2012 U.S. hospice industry has quadrupled since year 2000 Nearly half of all Medicare patients who die, do so as a hospice patient [twice as many as in year 2000] Business is Booming Push For-Profit Costly Care ALOS is Expanding Since 2006, the Justice Department has sued more than a dozen hospice companies II. What is Hospice? 1842 1863 1952 1967 1974 Origins of Hospice 4
II. What is Hospice? Emotional and Spiritual Support Quality Compassionate Care Expert Medical Care Nurses Therapists Volunteers Patient and Family Physicians Spiritual Counselors Social Workers Pain Management Home Health Aides Bereavement Counselors III. Hospice Facts and Figures Total Hospice Patients Served by Year Proportion of Medicare Decedents Accessing Three or More Days of Hospice Care 5
III. Hospice Facts and Figures Length of Service by Year Proportion of Patients by Length of Service (2013) III. Hospice Facts and Figures Location of Hospice Patients at Death Percentage of Hospice Patients by Gender Percentage of Hospice Patients by Race Percentage of Hospice Patients by Age Percentage of Hospice Patients by Ethnicity 6
III. Hospice Facts and Figures Percentage of Hospice Admissions by Primary Diagnosis Total Hospice Agencies by Year III. Hospice Facts and Figures Agency Type Growth in Medicare-Certified Hospice Providers Average Daily Census Total Patient Admissions 7
III. Hospice Facts and Figures Sample NHPCO Hospice Performance Measures (2013) Percentage of Patient Care Days by Level of Care What Hospice is NOT Courtesy of Leading Age, Minnesota 2015 Institute Palliative Care and Hospice 101 February 11-13 #215 8
Why Is Hospice So Difficult? Prognostication Grief Social Myths Ethnicity Race Government Intervention and Payment Physicians letting go Voice of Resident and Patients Lack of real data Bad Press, or Black and White Thinking Too many hospices to choose from Marketing tactics have become super aggressive It s the biggest choice of your life! Myth or Fact? Hospice is only for patients who have given up hope and are close to death. Hospice care takes place wherever the patient calls home, including skilled nursing and assisted living facilities. The focus of hospice is not only on medical care, but on the emotional, social and spiritual needs of the entire family. 9
IV. Expectations of Your Hospice Provider Patients and families drive the process Contact patient and family within one hour of referral Admit patients within 2-3 hours Available 24/7/365 Communicate on the families level Visits based on needs Evaluate pain every visit Answer phone within one ring No excuses Holistic approach IV. Expectations of Your Hospice Provider Admit based on criteria Coverage verified, up front and no surprises Cover all medications, supplies and equipment related to hospice illness On call 24/7 expect triage, not an answering machine Professional attire Language of your choice Not based on race, ethnicity or religious beliefs Bereavement for one year ALL four levels of care Education, support Part of your family 10
V. Marketing Techniques of Hospice Reps Selection Motivation: Money Past Experience Sales Techniques Segment Motivation Energy Focus on a goal of referrals. Referrals = Admits Goal is based on quarterly results with growth built in High degree of training Education In-Services Use of Staff Medical Directors Data Target Passion Each Admission = Payment Boat Runs Donut Runs Segment Deal With Set Backs Contests What you can ask Routing Questions to Ask Your Hospice Reps What is the mission of your organization? What are your Service Commitments? (at least 10 should be named) For Profit, Non-Profit? How many years in business? What areas do you cover? Reference List How long have you been there? Past experience? Is there an Executive Director? Hospice Medical Director? Accreditation 11
Questions to Ask Your Hospice Reps of Their Company Certifications? Licensed? Admission process Plan of care Services Inpatient care Patients rights and responsibilities Who is signing the hospice paper work to admit? Who is doing the primary evaluation? What does it cost? Do you have a 24-hour service? VI. Contracting for Success 12
VI. Contracting for Success Indexing to create appropriate hospice referrals and increase length of stay IF appropriate patient How? Form a multi-disciplinary community of team-based teams to address barriers to hospice Gather information Target Interview Findings Educational Collateral developed Courtesy of Leading Age, Minnesota 2015 Institute and Expo; Quality Improvement Organizations Lake Superior Quality Innovation Network Hospice Location Map 13
VII. Solutions and Resources Questions and Discussion 14