The coronavirus pandemic has impacted every aspect of hospice operations, including the way hospices market themselves. Increased difficulty accessing patients and declining referrals are some of the strongest forces driving hospices to adopt new marketing practices, but remaining competitive in a crowded industry during the pandemic has come with additional ethical considerations.
Since the COVID-19 outbreak hit the United States, hospices have struggled to access patients in settings such as nursing home facilities, hospitals and patient homes. As facilities and patients closed their doors to minimize risk of exposure, declining accessibility to both referral sources and patient families has negatively impacted hospice admissions and led to drops in revenues.
“There have been significant gaps in the use of both palliative and hospice during this pandemic,” said Shelley Cartwright, executive director of Apex Hospice in Illinois. “There has been a recognized significant decline in length of patient stay. Referrals are being provided at the eleventh hour and patients are dying within 24 hours, sometimes less. This is the biggest impact our agency has experienced as it relates to revenue.”
The pandemic is exacerbating a longstanding problem of patients entering hospice very late in their disease process. In 2017, nearly 28% of hospice patients had a length of stay of seven days or less, according to the National Hospice & Palliative Care Organization.
New anxieties around the COVID-19 outbreak haven’t helped. The reluctance of some patients and families to receive in-person visits has required hospices to adapt their patient education to provide reassurance about the safety of their services. Hospices have additionally found new ways to keep stakeholders informed of their revised safety and infection control protocols during the pandemic to those who could benefit from end-of-life care and services.
“Under normal circumstances, the most important objection hospice providers handle is the response, ‘We’re not ready for hospice yet,’” said Michael Ferris, managing partner at Healthcare Strategica, a sales advisory firm for post-acute care providers, including hospice and home health. “Handling that objection in the current pandemic environment comes with an additional objection of no one wanting anyone to come into their facilities or patient homes. It’s a huge and essential benefit just to let them know how you’re preventing risk of transmission.”
Declining numbers of referrals during the pandemic have challenged hospices to stay in touch with referral partners and form new partnerships. This has led to a rise in marketing expenses as organizations allocate spending towards increased outreach and communication. Much of face-to-face interaction that typically occurs across a patient’s continuum of care has been minimized to digital interactions, losing the personalized touch of emphasizing the value of end-of-life care to referring sources.
“Our census and revenue have mostly certainly been impacted by the lack of visibility, which equals real relationships,” said Cartwright. “We work in a world in which email, text messaging and social platforms have taken over. However, none of these have proven to be effective in marketing strategies, as [access] permission for visibility began to diminish in March 2020. It has been proven through this pandemic that we’re ‘out of sight, out of mind.’ The key will be not to allow this to be the ‘new norm’ for hospice marketing professionals. Our marketing team put their energy and focus on physicians and we began to see outcomes from our loss of hospital and skilled nursing facility referrals.”
Developing stronger ties to referral partners and new accounts has required increased communication and collaboration, including ramping up marketing strategies that state the case and financial value of the hospice care. Increased calls and texting, email marketing, video conferencing calls, webinars, and virtual events have been commonly employed tactics by communication and sales teams.
“One of the things that more successful hospices have been doing in this current period is communicating how they keep the most fragile and highest acuity patients out of those higher risk situations such as waiting rooms, hospitals and emergency departments,” Ferris told Hospice News. “Communicating how you can keep them safer than if they were not on hospice service is vital, along with mentioning telehealth utilization and what your methods are when a staff intervention in the home is necessary.”
Training sales leadership and staff to keep their referral partners’ priorities top of mind, including reduced hospitalizations is essential, according to Ferris, as is devising creative ways to connect with referring organizations without in-person contact.
“For sales professionals in hospice, the big value proposition for those referral partners, prospective accounts, and for the patients and families is that if the hospices can get the doctors to see that by identifying those fragile, at-risk patients and referring them to hospice before they require hospitalization, then they can help them have a better quality and quantity of life,” said Ferris. “That’s a message that can resonate.”
Advertising and outreach efforts have had to walk a fine line between advocating hospice service benefits to those in greatest need while also staying competitive in a growing marketplace during an economic downtown. However, getting the message out in a way that manages the crisis — without capitalizing on the national emergency — has hospices facing ethical decisions as they adapt their marketing and communication practices to the rapidly changing environment.
“Hospice services must respond rapidly, adopting new ways of working as resources,” said Cartwright. “It is truly that simple; being available 24 hours a day, seven days a week, without hours or days of delay and have flexibility in the means in which we provide response, shifting our resources and creating camaraderie without having to cross any ethical lines.”