This article is sponsored by Cardinal Health™ at-Home. In this interview, Hospice News sits down with Cardinal Health™ at-Home Director of National Accounts Robert Goodsell to learn how supply chain issues are disrupting the hospice industry — and what hospice agencies are doing to overcome them. Goodsell also discusses the power of data analytics in hospice, and why wound care in hospice and wound care in home health are not the same.
Hospice News: The COVID pandemic has created supply chain problems in all walks of American life. Give us an overview of what you see today in terms of supply management in hospice.
Robert Goodsell: I have been in the supply management business for hospice organizations throughout the country since 2004. As we’ve historically thought about supply management in hospice, the financial and clinical success for a hospice provider has largely centered around full accountability for supply usage.
When we think about supplies being ordered, it’s not just what’s being ordered — it’s accountability for how those supplies are being used. We’ve long advocated a distribution model largely driven by patient and staff direct supply distribution, and that helps an organization tie usage to both patients and ordering staff.
While the pandemic has certainly created a number of challenges, not only within hospice care but on the distribution and manufacturing side of supply need, it’s also reinforced the value of a distribution model that drives efficiency and safe delivery of supplies to where they need to be. So a patient direct, a staff direct distribution model, the value of that I think has been reemphasized during the pandemic. For example, staff don’t necessarily have to go to visit an office and unnecessarily interact with others, particularly during the height of the pandemic, when there were large concerns about that.
It’s also created greater sensitivity for organizations to maintain a certain amount of safety stock to protect against shortages. In most situations I’ve seen around the country within hospice, the trend has been toward patient direct delivery and reducing the amount of inventory that an organization had of supplies in the office, for example.
That trend has proved to be beneficial in the pandemic, but also has created some need and backtracking for organizations to ensure they have what they need when they need it.
A hybrid approach during the pandemic is what we have seen to a larger degree, both patient and staff direct. Organizations are making sure they have enough on hand at their offices, while some organizations set up essentially their own supply warehouses.
Given that Cardinal Health is both a distributor and a manufacturer, we’ve seen challenges from all sides. We’ve had a lot of work with hospice organizations with whom we did not have previous relationships. These were cases where we were maybe not the primary distributor, but they were seeking us as a secondary source to procure things that they were not able to find from their primary distributors. It’s been an interesting time, for sure.
What on-demand medical supplies are proving most difficult to get, and what should hospice agencies do to ensure that they can get these supplies?
Goodsell: Well, certainly PPE (personal protective equipment) has gotten its share of the headlines. Gloves, masks, gowns — all the personal protective items throughout the pandemic have been certainly challenging for organizations overall. That’s not only due to manufacturer shortage, but the demand, particularly in hospice, and really, all areas of health care, have accelerated, because previous demand was not an indicator of what current demand is in terms of usage patterns.
PPE, of course, was initially a huge issue. I think it is to a lesser extent today. Some product challenges have been rolling in nature, meaning they came and went over certain periods of time over the last year and a half or two.
So I think it’s hard to throw a net over one particular product category throughout the pandemic as things have been problematic and then resolved, but I think, again, organizations should just be mindful that they’ve got safety stock on key items that staff and patients need.
One of the things about our organization, certainly, is that we’ve got great relationships with national brand manufactures. Being a manufacturer of our own product allows us with our major product categories — incontinence or wound care, for example — to have significant manufacturing capability in the United States. That does help us have greater control over product quality, production, and shipping to our own distribution centers and elsewhere.
I know that you are a big believer in the power of data analytics in hospice care. What are the data points that every hospice provider needs to track that best show performance?
Goodsell: We are, and we have always been big believers in using data to help shape performance that yields the best financial and clinical results. We have used certain data points throughout time. With regard to the financial component, for hospice, the supply cost per patient day is certainly the leading financial metric in which hospice organizations view their supply spend.
A good example of looking at data is our CAREessentials™ interactive dashboards, which allow our agencies to look at specific patient supply usage by category, the staff that are involved and the products used. Just by looking at ordering practices for a given patient over the period of time that they’re on service, for example, allows us to question and look at the ordering practices of staff. Certainly we have safeguards within the ordering platform that we have, and there are safeguards inherent in the platform that allow for controlling supply usage and producing better results.
We use data to make sure that they’re optimizing PPD spend reduction opportunities and clinical practice opportunities. Even when the hospice agencies aren’t required to report specific patient usage to the patient level, we feel it’s important they track and they understand and use the data for actionable items to ensure that they are in line with proper patient care.
What is the biggest impact that the current hospice landscape is having on formulary management?
Goodsell: We’ve always been big believers in organizational formularies for patient and staff-specific supply use, but one thing that has been impactful on formulary management is the staffing issue, certainly a newsworthy challenge for hospice organizations, whether it’s the turnover or hospice aids or nursing staff.
One of the key things that’s really important is the need for continual and consistent training and/or retraining to ensure that staff is compliant with the organization. We feel it’s important for both, not only the ordering practice training, but also training around the products that the organization has elected to use.
The other important note is there has been, what I would say, a higher-than-usual operating process with regard to the need for alternate products, as manufacturers have had challenges over time for certain products. When we are working with an agency and the formulary’s been set up, we still need to be flexible and nimble. If we’ve got a national manufacturer’s backorder because a manufacturer is having trouble producing a certain item, we’ve got to pivot and find an acceptable alternative to place on formulary for staff to have access to that product for clinical needs.
That’s something that’s been an interesting challenge during the pandemic and as manufacturers have had their challenges.
What should hospice providers know about formulary creation and design, and product selection?
Goodsell: Again, having been in it a long time, one thing I’ve seen is an evolution toward hospices being more in tune with a formulary than they have been in the past. I think that’s important for financial and clinical reasons.
One thing that is important for an organization to be mindful of is that all products connect with each other and have an impact on the overall wellness of the patient. If the wrong incontinence choice for a particular patient is used, or the wrong sizing or wrong practice, then that might lead to skin breakdown, which is going to result in the need for treatment for that skin breakdown. If all goes poorly, that could put the patient in the hospital.
It’s also important to remember, particularly in wound care, that wound care in hospice and wound care in home health are different. In hospice, it’s more about wound management versus wound treatment because the body is just not going to be able to help with that overall healing process as it normally would if a patient was more on the healthy side. Just making the right choices and understanding a hospice patient’s need versus what a home health patient needs for wound care products is really important, along with the sizing and so forth that we talked about with regard to incontinence products.
How can data help with consistency of patient care?
Goodsell: Again, it’s not just the data. It’s what you do with it, the analytics side, and then pulling all that information together and creating actionable items for an organization to determine not only what the organization is purchasing but creating the guidelines and specific practice consistencies to allow for good, consistent clinical care.
We’ve used data, dashboards and other information in collaboration with the customer to point out the differences or the outliers — the information that allows them to best understand how the staff is using supplies versus how they should be using supplies in shaping clinical practice.
This is about making sure that the organization that we’re working with is in tune with the ordering pattern being aligned with clinical care practice. This ensures that they’re not over-ordering and that staff members are applying the right clinical care for what each patient needs.
Finish this sentence: “The hospice industry in 2022 will be the year of…”?
Goodsell: Consolidation.
Editor’s note: This interview has been edited for length and clarity.
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