NPHI CEO: ‘Bring Our Care Model to Patients Pre-Hospice’

As President and CEO for the National Partnership for Hospice Innovation (NHPI), the question, “What’s New?” is an important one for Tom Koutsoumpas, who took the helm of the industry organization in 2015.

NPHI is a coalition of non-profit hospices that collaborate on moving innovations forward, in terms of service diversification, discovering new payment models, implementing technologies and efficiencies, and uncovering new approaches to delivering care.

“What we have done with the partnership is to bring together the most innovative community-based nonprofit hospices in the country in a way that fosters dialogue, discussion and exchange of information, particularly about innovation and innovative ideas,” Koutsoupmas told Hospice News.


Earlier this year, NPHI founded its Innovation Lab to further this mission. The lab will study new initiatives from the organization’s hospice members to uncover best practices and help other providers adapt them for their own programs.

Hospice News recently caught up with Koutsoumpas to talk about how the hospice landscape is evolving.

How does NPHI work to advance innovation in hospice?


We brought NPHI together to create ways to support hospices our through innovation, through group purchasing, and to use the scale of a national organization to support each local program.

These programs are often the sole providers in their communities. They have deep roots in their communities, and they often take care of patients that others don’t. A lot of programs are pursuing new and unique initiatives independently, so we bring them together to foster innovation through dialogue and interaction.

We are focused on using our experience from the past to advance the future. We seek new ways to better care for patients and families, to support patients in regards to social determinants of health and prepare for the future.

What are some examples of some of the innovations that your members are pursuing?

A number of our programs are working with their local communities to incorporate different kinds of care designed specifically for Alzheimer’s patients. If you look at what’s happening demographically, the growth of the number of people who have Alzheimer’s is staggering. Hospices are asking how we can better care for them and design a model to support them.

Programs across the country are doing this, and others are learning from them how to put something like this together.

Many programs have been incorporating activities to address social determinants of health that go way beyond traditional hospice care, asking how we can address issues in the home and living conditions to support management of their disease or diseases.

A number of organizations are also looking at the advanced illness population and beginning to develop home-based primary care programs. These programs adapt the model of care that we built with the Medicare Hospice Benefit in 1982 and replicating it for the pre-hospice population — people who are aging and will not get well but who are still very vital. We can support them and care for them using our expertise, our interdisciplinary teams and our focus on the whole family.

These patients may have multiple conditions that need to be managed, and hospices can effectively care for people much earlier in the trajectory of their illness.

A number of hospices are developing [Programs for All-Inclusive Care of the Elderly (PACE)] programs, and while PACE isn’t new, what is new is that hospices are really moving into the PACE arena.

Earlier this year your organization founded the Innovation Lab, how is that work progressing?

The Innovation Lab is bringing new initiatives from around the country into our organization, analyzing them, identifying best practices that then disseminating that information to our members so they can implement them within their own organizations.

For example, we are looking at ways to support heart patients more effectively. We will be announcing our new heart initiative later this year. We have been working really closely with the American Heart Association to look for ways to better care for our patients with severe heart issues.

The lab is also looking carefully at the Medicare hospice carve-in demonstration to figure out how we can best position ourselves to work with payers to help ensure that the carve-in works out in a way that supports the best interests of the patient as well as everyone else who is involved.

To that end, the lab has been looking at the Medicaid arena, saying that we are working with managed care through the Medicaid side, maybe we can replicate some of those concepts within Medicare Advantage.

What are you hearing from your members about the forthcoming carve-in?

I think there is a lot of fear that the [hospice care] model will be deconstructed or that the reimbursement won’t be sustainable.

We are encouraged that this is being tested before it gets implemented into statute. If you are going to do something as dramatic as changing the law around an important benefit, you have to test it first because there could be a lot of unintended consequences.

So there is concern, but there is also the opportunity during the next few years to see what works and to really get it right.

A number of your members’ initiatives involve service diversification. Why is diversification becoming so important to hospices?

A number of years ago my mother was aging and became ill with multiple chronic diseases. From age 82 to 86 she was in and out of the hospital and repeatedly visiting the emergency department at night. There was no organized system of care.

She ultimately went into hospice, and her care was just the way it should have been. They took care of her. They took care of my sister, her caregiver.

The only problem was this: For the four years before hospice it was chaos.

Health care is changing in this country. We have thousands of people aging into Medicare, and their needs are overwhelming. We need to think about ways we can we take the skills that we have from providing extraordinary care through the hospice model and apply that pre-hospice.

We have seen the rise of palliative care for instance. We need to be front and center with those kind of care delivery models. We have done a lot for the terminally ill, but we missed the pre-hospice population that will age into hospice.

I was very active in 1982 in trying to develop the Medicare Hospice Benefit. As we talk about how we can create a better health care system, people start saying that we need an interdisciplinary team approach, that we need a psychosocial and spiritual component and all the other components. Well that’s we what we did in 1982.

Now we need to look at what we created, which was way ahead of its time, and build on that. How do we take that experience and replicate it into new models and that is helping to drive people into those new care models? It’s a natural progression, and it will have a big impact on health care delivery.

Many hospices are incorporating palliative care into their service lines, but most are not generating enough revenue to sustain their programs, and they rely a great deal on philanthropy. How do you think that could be turned around to help these programs break even or achieve a margin?

I think the recent announcement of the primary care initiative from [Center for Medicare & Medicaid Innovation] will begin to lay the foundation for that, and I have been encouraging our members to develop home-based primary care programs.

The new models that have been designed are just that: It’s Primary Care First. It’s bringing the primary care physician and the interdisciplinary team to care for patients in the home pre-hospice, and I think that will lead us to the future. I think ultimately there will be a payment model that supports that care for the pre-hospice population.

Likewise, how do hospices make programs to assist with social determinants sustainable? What kind of capital investment is involved?

I think certainly among our members many use philanthropy at this point to support additional services to address social determinants.

I think moving forward there is an opportunity for us to show payers the impact of these services, that they are an effective addition to the care that we deliver and can prevent hospitalizations and at the end of the day it’s a win-win for providers, patients, and payers.

We are moving towards those things. We just need a little more time to show the difference that makes.

We have been very myopic in our health care system in general. Health care focuses on the symptoms and the disease, but what about the other issues?

An elderly person in the home who suffers from [chronic obstructive pulmonary disease] may go in and out of the hospital or the emergency department on a regular basis, but nobody has looked at the fact that she has mold in her ceiling or in the vents that are triggering these constant breathing issues. We should be looking at all of these factors.

We will see this moving in the right direction, and payers in the long run will work with us on reimbursement. CMMI has also been looking at this, and it will make for a better America and a better health care delivery system. We just have to pull it all together.

How are nonprofits contending with ongoing staffing shortages that are expected to worsen in coming years?

That is one of the biggest challenges for hospice, as it is for the entire health care system.

We are looking at working with nursing schools, with medical schools, with developing fellowships and helping people get more informed about end-of-life issues. We hope this will attract more clinicians and professions toward being a geriatrician or a palliative care physician or being a nurse practitioner focused on this area, for example.

I think what will attract people to us is our mission. We have a lot of people who really believe in that mission, and they want to work with us. A lot of prospective employees in hospice know they might be able to make more money elsewhere, but they say that they really believe in our mission, and we can use that to attract people.

Beyond that it’s working with schools to bring in more nurses and social workers and members of other disciplines, and that’s something we are trying to do on a regular basis.

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