Changemakers: Carla Davis, President, LHC Group Heart of Hospice Division

Carla Davis is the president of LHC Group’s (NASDAQ: LHCG) Heart of Hospice Division. She previously served as CEO of South Carolina-based Heart of Hospice until LHC Group acquired the agency in August.

Davis came to Heart of Hospice with diverse compliance, operational and sales experience including as chief operating officer of VistaCare, and vice president of sales and marketing at Heartland Home Health Care and Hospice, a division of HCR ManorCare.

Davis kept Heart of Hospice on a growth trajectory, with a focus on same-store, organic growth. She has a strong background in compliance including experience with one of the country’s largest Medicare Administrative Contractors, Palmetto GBA, educating and regulating hospice providers. She has helped initiate and execute hundreds of hospital and hospice partnerships across the country. Davis serves as a board member for the National Hospice and Palliative Care Organization (NHPCO) and as the president of the Alliance for the Advancement of End-of-Life Care.

Davis oversaw the establishment of two Heart of Hospice subsidiaries: Palliative Care at Heart and Supportive Care at Heart, as well as instituting a new inpatient hospice unit dedicated to COVID-19 patients within a matter of days.

Can you speak to some of the most significant changes that you’ve seen impact end of life care in recent years?

The move to value-based care and the importance of hospice in that conversation has elevated over the last three-to-five years. I am finding that more hospital systems and payer systems are understanding it, or can understand it when you explain it to them. Whereas in the past, I think they saw hospice as sort of this afterthought and a nice thing to do, but they didn’t really understand the true value of the service to the health system or the payer.

We have seen significant industry consolidation, and this movement is only going to continue as recognition of the value of hospice — to health care systems, payors, and investors alike — accelerates. Growth of the benefit has led to increased regulatory requirements and oversight, requiring more knowledge and investment by hospice providers to stay compliant with the heightened regulation.

As the industry becomes more sophisticated technologically, also as a product of growth, and as innovation introduces new ways of delivering and managing care, it, too, requires investment. It will be difficult for small providers not associated with a larger parent organization to survive. Because of this, size does matter; various efficiencies come with scale, and sheer size itself better positions providers to partner with health systems and payors.

Encouragingly, a lot of the recognition of hospice’s value is driven by an interdisciplinary approach better accounting for social determinants of health than other care options. Hospice and palliative medicine are crystalizing as important specialties. The larger health care industry is beginning to understand that for a small percentage of the population with extremely high-acuity illnesses, care requires more than just physical symptom management. An interdisciplinary approach considers the whole self and ensures patients’ emotional, social, and psychosocial needs are met.

When I got to Heart of Hospice in 2014, they were still selling with cookies and coffee cups. I told them what the future was going to hold in terms of the sales process, because what is important to our consumers has drastically changed. There’s still a lot of change that needs to take place along that spectrum in terms of them really understanding the value but also being more focused on quality outcomes.

I don’t think that there’s consensus yet in the industry about what are the most important groups of outcomes. I think with the [Fiscal Year 2020 hospice rule from the U.S. Centers for Medicare & Medicaid Services (CMS)]. We’re far behind most of the other provider segments, but definitely moving in the right direction.

Hospices are also looking to differentiate themselves on a broader scope of service. We find that there’s things that we need to measure to ensure that we’re doing that well.

Can you say a few words about how hospice and palliative care providers need to adapt to this changing health care environment?

We can’t keep doing things the way we’ve been doing them. What hospice will look like tomorrow isn’t what it looked like yesterday. Some people have sort of stayed relatively in the same place and haven’t evolved. Their products haven’t moved upstream to serve people prior to their six-month terminal prognosis. I think there’s a lot of innovation that still can take place within the current hospice benefit. There’s lots of conversations going on about Hospice 2.0, but there’s still room to do more within the current construct of this amazing benefit.

We need to position ourselves as an end-of-life care leader, look at ourselves outside of what we’ve always done and definitely move upstream.

Can you elaborate on the term Hospice 2.0?

NHPCO is working on advocating for an evolved benefit. There are barriers to people accessing care today, and we want to make sure that there’s equal access for everyone. We also want to make it as easy as possible. People have different opinions about what those barriers are, but certainly feeling like you have to give up curative treatments is one of them. Some people believe the six months or less demarcation, which was relatively arbitrary back when the benefit was enacted, is a barrier because the physician feels hesitant to say that.

We have found ways to overcome most of those barriers and to try to get everybody who’s dying access to care, but certainly with only 51% of the people that are eligible for hospice electing the benefit, we still have ways to go. I mean, we’ve come a long way, really long way, but we still have a ways to go.

We want to figure out what the next evolution of the hospice benefit should look like. What should a palliative care benefit look like? How do those two things fit together and touch each other so that there is a seamless continuity of care?

COVID precipitated a great deal of change for health care and hospice in particular. What do you foresee as some of the long term impacts?

COVID brought out the best and the worst of our health care system. For us the impact of COVID was really market to market. We leaned into COVID, and opened the dedicated inpatient unit overnight in New Orleans. Each community is so different, and a lot of that, sadly, has to do with the availability of beds. If hospitals had beds, they are more likely to hold the COVID patient.

People have a heightened awareness now of two things. One is to have conversations about your choices at end of life early and to communicate those. Even in my own family. My mother is 84, and she doesn’t have an advanced directive. I did get COVID from my mother, and she got it from my brother. This was over a year ago, actually. After my brother got sick, I brought her into my condo to get her away from the danger, and then she brought the danger to me and my husband. She was pretty sick at one point, but not to the point where she had to be hospitalized. Nevertheless, I was very, very worried.

I just remember having a conversation prior to her getting in that truck. Do you want to go to the hospital? Do you want to be on a ventilator? What’s important to you? You take for granted that you have another day, but you should document what your choices are. I think that is a really positive thing.

How do you feel that the work you’ve been doing helps to drive change?

I was fortunate enough to be taught and mentored by people who really did establish the hospice benefit. They taught me how it was supposed to be in regards to access to care. I had to actually get into the regulations and realize the truth of what is there. Our mission is to serve everyone who is hospice eligible and find ways to overcome barriers to access to care.

Taking a patient on chemo, taking a patient we have to travel on a boat to see, figuring out a way to say yes to a child whose mom wanted to go home and swim in the pool one last time are a few of the situations we find ourselves in. We figure out how to take the grandpa home and do an in-home examination with the doctor at the bedside.

The hospices around us are saying yes to those kinds of questions a lot more. From a competitive perspective I think that’s the right thing. High tide raises all boats, and we need to determine how we need to change. We need to make it easier for people who are dying to get access to care, to knock down the barriers. Racial issues are one of them. Cost is one of them. Location of care is one of them. Having a caregiver is one of them. There’s a lot of barriers to getting access to care, and we are determined to overcome them.

Heart of Hospice was recently acquired by LHC Group. What drove the decision to consolidate?

We are thrilled to join the LHC Group family. Heart of Hospice will maintain the same excellent service and compassionate caregivers, but with the additional benefit of supportive infrastructure and health system and payor partnerships forged by LHC Group in the 27 years since its founding. Together, we are ready to continue growing, mission and vision first.

Heart of Hospice comes to the table with a strong reputation for quality and compliance, as well as a combined 150 years in executive hospice leadership. As one organization, we are equipped to implement best practices and capitalize on synergies to design hospice anew for the entire LHCG family. It’s all about helping people as we work to transform end-of-life care in the communities we serve, and LHCG is ready to do that on a larger scale than ever before.

While the hospice benefit has grown since its inception in the early 80’s, today, only 50% of the people that die in America die with access to high-quality hospice care. With the resources and platform of LHCG, we will be able to break down barriers to access and help more people. I look forward to joining LHCG’s hospice leadership to transform end-of-life care across America.

Unlike other major providers, Heart of Hospice and LHC Group care for both small and large communities. One of the unique organizational tenants we share is our commitment to serve all people, including those living in rural communities who want to remain there and still receive high-quality care. Health care is best provided at home — where you live and where you are comfortable — regardless of whether that is a small town or a big city.