Well-known in the hospice field, Clevis Parker, M.D., chief medical officer of ProCare Hospice in Nevada, was recently named CEO of that organization. In addition to leading the organization, Parker will continue to also serve as chief medical officer.
Parker came to ProCare last year after serving as chief medical officer for Nathan Adelson Hospice, also in Nevada. Board-certified in family medicine as well as hospice and palliative care, he previously served as hospice medical director for Parkview Hospital in Forth Wayne, Ind., as well as medical director of Hospice of Yuma in Arizona. In addition to being a medical doctor, Parker holds a master’s degree in Health Administration with a specialization in health care ethics.
Parker recently sat down with Hospice News to talk about taking the helm of a hospice in the midst of a pandemic, forthcoming Medicare payment models, and his priorities for ProCare.
Would you introduce us to ProCare and give some background on the organization?
Our average daily census was around 200. Now we’re around 190. We have a unique offering. For adult hospice patients, we have a couple of specialty programs. We have a cancer program, where we have pain specialists who will field intrathecal pumps, and we do absorb that cost.
Most home-based organizations are not able to refill the reservoir [for the intrathecal pumps] in the patient’s abdomen. That’s a service that we perform. That’s definitely not something that we see a lot of in the hospice field. It’s typically very pricey.
We have one of the largest pediatric censuses in the West. We’re averaging almost 80 pediatric patients. We helped develop the manual for the state of Nevada with the governor and his committee when the Affordable Care Act was enacted, and Nevada decided that they wanted to do the concurrent care for pediatrics. This group at ProCare worked directly with the Medicaid personnel from the governor’s office to develop and implement the pediatric palliative care/hospice program.
We have two specialty trained doctors in the pediatrics program. One is a neonatologist, and one is a pediatric hospitalist. They helped direct the care.
Are all those services provided in the home?
Yes. Of course some hospice care is provided on an inpatient basis, so we contract out with different inpatient facilities to provide that, but most of our adult and almost all of our pediatric service is in the home setting.
As you come into this new role as CEO, what would you say are your top priorities?
It’s stabilization because of COVID, and some of the turnover that we’ve seen just in the industry itself, to which we’re not immune. Everybody has had it in the hospice and home care side.
Stability is number one, and then expansion, expanding and growing our census. We have a unique opportunity on both sides. Because now that we are physician-led, it truly does send the message to the rest of the community that we take providers seriously. At the end of the day, hospice is still a health care delivery model where you must have physician and provider engagement. Most organizations that I’m aware of do that, but not at the level that we are.
We’re committed to compliance, so to ensure we maintain our compliance, growth, stability, and certainly the quality.
In addition to leading the organization you are continuing as chief medical officer. How would you balance those responsibilities?
Great team support, putting the right people in the right place. So hiring and making sure that the operation side runs smoothly. It may all funnel up to me, but at the end of the day we’re one team.
We have a good leadership vision, but we’ve got to have commitment and engagement from the rest of the team. We hired the right people. We hired a good chief operations officer. We’ve got a good CFO. We are putting the other pieces around and making sure that most of the day to day operations can work without me interfering.
I still will see patients, I still do face-to-face visits. I still speak publicly and do all the other things as the CMO. I have a host of other physicians who work with me to make sure that we’re addressing the needs from the medical side. It’s gonna be interesting to see how we kind of navigate it, but it’s certainly very doable if you get the right team behind you.
What are the benefits to the organization of combining those two roles?
As a physician, I wasn’t willing to give up my practice, And when you’re also balancing that with the CEO position, the buck stops with you. That certainly is a different role, but I think it makes a lot of sense for our organization because of the environment that we’re practicing in. We have lots of different hospices here in the Las Vegas area, We’re not a certificate-of-need state, and a lot of them are non-clinically led.
Our board felt that there’s no stronger statement than to put a physician at the top. He is the face of the company, and he’s going to continue to see your patients and find a way to balance them. I think it just adds a little validity in our area, because we don’t have a lot of physicians involved intimately in the hospice care in our area
Could say a little bit more about how ProCare has fared thus far during the pandemic?
It’s been a whirlwind. There’s something happening every day. and what we learned from that is that you never really know what you don’t know until something happens. Initially we did many of the same things as most people. We closed offices, as we were told to do so from the state. Even though we’re in the health care industry we tried to eliminate the risk and exposure to the workers that were in the administrative team and provided them with access from home laptops, printers, internet, whatever we needed to do until we were more comfortable coming back.
Now that we’re a little bit more comfortable coming back, we put in protocols and policies for temperature monitoring daily. When staff come into the office, they have to screen first.
Staff also have to check in before they start a shift and make sure that they don’t have any symptoms or a fever and if you do, you quarantine and we test them.
We’re trying to respond to all the regulatory changes that [the U.S. Centers for Medicare & Medicaid Services (CMS)], and we had to address shortages of [personal protective equipment (PPE)]. For a time, we couldn’t get any. Now we have adequate PPE.
We’ve had some turnover in the nursing side. Some because they’re fearful, they didn’t want to go back to work, and they did not want to see patients in the home setting. So we’ve had to come up with alternative ways to provide additional protection and make sure that the staff felt as safe as they could with our patients.
What we’ve done is we’ve gone to a 3M respirator, which we have disseminated throughout the organization, including most of the nursing staff. We’re still ramping up dissemination into the other interdisciplinary team members like spiritual support and social workers. We will all be out wearing these gas mask-like apparatus. The protection from those things is a little bit more solid than the protection from an N-95 [mask].
For some of our pediatric patients, we still have to wear the N-95 or the KN-95, because at that age they’re fearful. They’ve got somebody coming in and looking like an anteater or a space person. But we are seeing more and more organizations be more aggressive with PPE protection, and in the end it’s more cost effective.
What have you done to try and stem the tide of that turnover that you’ve seen since the pandemic began?
We’re trying to educate the team in-house, how we want to protect them and how we want to invest in them. We’ve given some bonuses for people to stay on, and we’ve done some sign-on bonuses to attract and recruit staff members.
We’ve got a good complement of people entering into our program now to provide that support. But it really was trying to educate as much as possible, telling them what we know and that we are protecting them 100%. We were striving to do whatever we could to make sure people understood what to wear, what questions to ask before going into the home. We gave them the ability to do telephonic visits and telehealth visits as allowed by CMS. We just tried to reassure all the people that were here and also the incoming people that we were invested in their protection.
How has the pandemic impacted the organization financially?
We were at 220 census, and now we’re at 195. So we dropped initially. We had been growing before the pandemic. Then throughout the summer, we’ve seen a slowdown, and we’ve lost a little bit of our census. I think the pandemic contributed to that slow down, but there are other factors. It’s typically more slow in summertimes because there aren’t many infections, so there’s fewer hospitalizations.
With COVID coming along, it certainly has boosted that. The problem is that as COVID increased in the hospitals, and they were shutting down elective and other procedures, people were staying home. They didn’t seek out medical attention. Nobody was coming into any of the physician offices, and so it made it a little bit more challenging for us to get referrals.
Now, it’s coming back. One physician office we work with is now busier now than it was last year, which is incredible.
You and I have spoken in the past about the new payment models that are coming to hospice in 2021, including Medicare Advantage and Primary Care First and the Serious Illness Population model. How are you going to approach those changes at ProCare?
We are trying to prepare for the carve-in with Medicare Advantage. We have a good bit of our patients on our adult side who are members of a Medicare Advantage plan. We have that access and that leverage because we’re already providing good quality care for those individuals. Now it’s about contracting, but we can’t do anything until we know who’s going to participate in our area.
We have not been told if there’s any insurance companies who are going to participate in the carve-in demonstration. We’re waiting on that, and that’s a little bit unusual. I think a list was supposed to come out in July or June, and then [CMS] pushed it back. We’re still trying to see if this is still even going to happen.
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