Referrals Key to Hospice Business Growth

As demand for hospice care grows, hospice providers in an increasingly competitive marketplace are working to bring a larger share of those patients under their wings. In addition to traditional methods such as territory management and improving call volume, many are finding that the key to successful marketing is building relationships—with referral organizations, physicians, and ultimately the patients.

Relationships of any kind are built on the same pillars: Communication, trust, understanding of each party’s needs, and understanding how the relationship will support those needs. Hospice organizations are increasingly integrating these principles into their marketing strategies.

“Build relationships and your business will grow,” said Shelley Cartwright, administrator of Westmont, Ill-based Apex Hospice and Palliative Care, in a presentation to the Illinois Homecare & Hospice Council. “Hospice is evolving. People are recognizing that it’s a need, and the industry needs to evolve in a timely manner.”


Hospice care is inherently collaborative. Patients receive care not from a single clinician but an interdisciplinary team. Expanding the scope of collaboration to include referring organizations such as hospitals, long term care, and skilled nursing facilities can boost referrals as well as support quality patient care.

Referring organizations have their own priorities in terms of business performance and quality of care. A nursing home, for example, can see a 2 percent reduction in Medicare payments as a penalty for high readmission rates, which can virtually eliminate their margins. They would want to know how their hospice contractor can help control those rates.

“Adopt a consultative sales approach,” Michael Ferris, advisor at the consulting firm Healthcare Strategica. “If I can get the referral partner to tell me about the problems they are dealing with on a daily basis then I can align the solutions that I present to those needs. Show them the hospice can help their practice run better, as well as reduce readmissions, and costs for high acuity patients.”


Hospice has a solid track record on addressing these kinds of issues. Poor-prognosis cancer patients enrolled in the Medicare Hospice Benefit experience considerably lower rates of hospitalizations, intensive care admissions, and invasive procedures, and see significantly lower overall health care costs during the last year of life, compared to non-hospice patients, according to a 2014 study. Additional research has found similar trends among congestive heart failure patients and patients who contract pneumonia.

Marketing staff can leverage publicly available quality data to identify some of the organization’s concerns before initiating contact, helping them get a head start on these conversations.

“Visit Nursing Home Compare or Hospital Compare, and pull up a survey,” Cartwright told Hospice News. “Look at their quality measures and staffing data. If they need to improve on pain management, go in and talk about your pain management program. Show them how you can help improve their quality and patient satisfaction.”

In many instances, hospice representatives will approach physician practices, nursing homes, and other potential referral partners with gifts, such as free lunches, looking for an opportunity to educate the organization’s staff about the benefits of hospice care. This can get them in the door. However, training the sales workforce to engage in enhanced conversations about client and patient needs is often a better investment.

“It comes back to training sales people to initiate conversations about the referrer’s problems, stresses, and frustrations, because in many cases hospice can be the solution,” Ferris explained.

Education continues to be a key aspect of hospice marketing, a spectrum of stakeholders from patients and families to referring physicians can benefit from a better understanding of hospice care. Community-dwelling adults have a low level of awareness of hospice and palliative care, and misinformation was common, a March 2018 study in the American Journal of Hospice and Palliative Care found.

Part of this education involves reaching not only referral sources but wherever possible speaking directly to health care consumers. For example, Illinois-based Apex hospice recently provided an education program to their chaplains, who in turn communicated with Lutheran clergy in their service area. Some of these allowed the chaplains to speak to their congregations about the value of hospice care.

In the Seattle area, Paul Cunningham, M.D., senior medical director for Coordinated Care Washington, offers classes, free to the public, about advanced care planning and end-of-life decisions. Programs like these can help patients understand hospice and be more open to referrals when it becomes necessary.

Strategies to boost referrals is critical to growing hospice business, but providers are increasingly finding that what happens after they receive a referral is equally important than their most effective sales pitch. Health care providers value hospice partners who use efficient workflows to ensure smooth and timely care transitions for their patients, and reduce their own burdens related to those transitions.

Achieving this requires more than a sophisticated sales force; intake, referral management, and clinical staff each have a role to play in effective care transitions.

“We need to make it as easy as possible for both the referral partner and for the patient and family. After they have identified the [hospice-eligible] patient, making the process easier for the patient to transition to hospice will in the long term win the battle,” Ferris explained. “Hospices turn away business all the time either by being difficult to work with, putting the onus on the consumer or the referral partner, or having workflows that delay the services that individual and family needs.”

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