Hospices Tackle Quality Improvement as Medicare Advantage Approaches

A focus on quality improvement can enhance patient care as well as a hospice’s bottom line as they prepare to demonstrate their value proposition to payers when the Medicare Advantage hospice carve-in comes in 2021. Providers can benefit from transforming their organizational cultures and moving their workforce towards a pay-for-performance outlook in anticipation of the payment model changes.

“When we look at quality care provision, providing high-quality care and experience in a patient center model is a necessity and not just nice to have for today’s hospice provider,” said Jennifer Kennedy, senior director of regulatory and quality for the National Hospice and Palliative Care Organization (NHPCO) in a recent conference. “When you look at health care and quality in the United States, we have the highest rates of avoidable mortality because people aren’t receiving timely, high-quality care. The government is really invested in making sure that the cost of care is within containment, but also that the quality of care isn’t lost when dollars are contained being spent on health care. The aim is to really improve overall care by making care more patient-centered.”

Hospice leaders are creating change from the inside out in anticipation of the Medicare Advantage carve-in, slated to begin Jan. 1, 2021. Despite proposed legislation seeking to delay implementation of the value-based insurance design (VBID) model demonstration project to start in 2023, hospice providers are bracing for impact and strategizing sustainable best practices. Investing in workforce and reevaluating staff policies have been strategies in aligning with the upcoming payment structure changes designed to improve quality and experience of patient care.


“We’re seeing payment models that are being developed at the [U.S. Centers for Medicare & Medicaid Services (CMS)] level that are really focusing on innovation and value-based purchasing,” said Kennedy. “That is here to stay, and we’ll see moving forward. Workforce development is really an investment in people to prepare the next generation of health care professionals and support that lifelong learning for providers that they will need in order to provide high-quality care. Organizations have the opportunity to deliver quality care to their patients and their families by committing to developing a culture of continuous quality improvement and patient-centered care. Having a person-centered model is not enough. It needs to be adopted into that organizational culture.”

Focusing on reducing turnover and minimizing staff shortages have been ongoing struggles as hospice providers work towards patient-centered care. Embracing a culture of quality can lead to less employee frustration and turnover, more successful regulatory surveys, better satisfaction scores and improved community reputations, according to Kennedy.

Strategies in shifting towards continuous quality can include employee self-assessment surveys to determine areas of need, as well as ongoing performance improvement evaluations with transparent expectations from hospice leadership. Involving staff across different settings in brainstorming and implementing best practices for quality patient care improvement is another tactic to encourage workforce collaboration and commitment.


“Currently, we are doing a pay-for-performance model for our staff and it’s creating a cultural shift,” Sarah McSpadden, president and CEO of The Elizabeth Hospice in California. “Takeaways from the shift in performance is to keep the standards objective to ensure that they’re accountable and measurable. Include all the stakeholders in the rewards determination. Talk about quality with everyone in the organization and celebrate it often. Celebrate the tick up in something you’re measuring. Celebrate all the changes you’re creating in better patient care outcomes for the people in your community, and then make success possible on an individual basis for accountable staff that uniformly follows standards and holding each other to them.”

Moving towards a pay-for-performance outlook can financially incentivize a hospice to follow and implement improved standards of care for patients and families. Strategies can include both medical and non-medical areas of patient care, enacting systems to measure feedback and experiences to improve care delivery across an organization’s continuum.

“We are steadily moving in the direction to develop pay-for-performance, value-based payment models that really attached financial incentives and disincentives of providers as part of the national strategy,” said Kennedy. “Developing a culture of quality is continuous. It’s not that you’ve reached this particular goal and now you can sit back and relax. You’re constantly self-assessing where you can make improvements in your organization. If you haven’t dedicated resources to a quality improvement culture and system, you’re not really going to be successful in these payment models.”

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