This article is sponsored by CareXM. In this Voices interview, Hospice News sits down with Kristy Fisher, Director of Nursing and Clinical Operations at CareXM, to learn how hospice providers are doing more with less in an effort to add time back into nurses’ days so they can focus on patients. She explains how CareXM is supporting this initiative with technology solutions like Care Triage to improve the care experience for patients, families and caregivers, and she provides an outlook on the transformation of care delivery in the next 5-10 years.
Hospice News: What career experiences do you most draw from in your role today?
Kristy Fisher: My background is in nursing. I started out in oncology then moved into the hospice arena, eventually falling in love with that space. My experience in patient oncology gave me the opportunity to care for a lot of end-of-life patients and others who came into the hospital with a quick diagnosis then went home to pass away. Those were the patients I took a kinship with, and that’s where I determined to focus my career on hospice.
What led you into hospice care and what were the steps that led you to where you are now with CareXM?
I loved taking care of active dying patients. Hospice has a continuum that starts with a six-month prognosis and continues with them through end of life. But the challenge in the world at that time was that many well-intentioned physicians wouldn’t refer to hospice until the last minute, so sometimes patients would even pass away in transport to their homes.
Those types of opportunities and experiences really gave me a desire to help increase the awareness and acceptance of the hospice world and its services. Over the past 20 years, it has become more and more known, though we still face some of the same resistance and stigma that hospice is considered “giving up.”
My role today as a director of nurses in the triage world is centered on supporting hospices that are being challenged by the acute problems of their patients. As they transition into the end-of-life stage, issues will come up that you just can’t predict.
That’s where the triage and after-hours piece comes in. That’s probably the most unpredictable, most chaotic piece of the puzzle, and that’s where I live today. My personal mantra and the entire CareXM business philosophy is to support the success of our clients’ patients and their experiences by providing good, quick access to nurses and care, but also to the nurses themselves.
I’ve been the triage nurse after hours. I’ve been the one on the other side of the phone. I’ve been at patients’ houses receiving calls, stressed because I couldn’t be in multiple places at once. I love what I do today because I get to help de-stress some of those instances and improve the patient experience.
I’ve been able to participate in building this company at many levels, but with having kids and other obligations, I was also able to scale back as needed. It’s one of those things where, in the nursing world, you can go all-in or you can go part-time, but you’re always able to help people and improve their experiences, especially at the end of life. That’s what hospice nurses are there for: to be a guiding light during a time of transition for both patients and loved ones.
What do you see as the greatest challenges within the industry today, and how is this different from when you first started?
There are several challenges. As an industry, a lot more people are being referred to hospice and we’re struggling to meet the demand with fewer staffing resources and a decrease in funding. I think that’s the big picture.
The small picture includes things like the transition from paper filing to EMRs. I remember when nurses would make visits and come back to the office to chart for hours, and while it has improved somewhat, EMRs have their own challenges. Overall, the industry is using tools like this to do more with less so they can focus on the patient, not on the day-to-day.
How much time do nurses spend chasing a doctor to get a new order? How much time do they chase the vendors to get their DME equipment out there? How much time do they spend charting?
Charting is incredibly painful. You get on any social media forum that supports hospice nurses and you’ll see the same sentiment. We have a lot of nurses who don’t want to be case managers because of charting. They’d rather go and be a visit nurse or a PRN nurse so they don’t have to do the charting. I think that’s one of the greatest challenges.
We have to find a way in this world where we can dot the Is and cross the Ts to get that stuff done, but minimize the time it takes so the focus is truly on the patient. We’re really good when we’re in front of the patient and we can take care of them, but all the other non-care-related tasks take away from that.
How does CareXM support hospice patients and their families?
The cool thing about CareXM is that we have transitioned from being a simple triage company. We’ve always supported our patients and clients to make sure they have access to a nurse in a timely manner. That’s the crux. If someone is calling after hours, we support our clients so they can focus on the patient. We’ve spent the last two or three years building automation technology to further support the triage process.
We want to enable clients to focus on patients with technology solutions that help organize the triage communications so that if a patient calls in, they are connected whether the nurse on call can answer or not. We have a coordination platform that helps us to organize who the patients are calling, who’s having problems and who needs to go where. So we just combine all of those technology solutions and services to increase the focus on the patient. It’s quick, it’s streamlined, it’s efficient. We have to let the nurses do what they need to do — focus on caring, assessing and coordinating care for the patient.
What partners does CareXM support, and where do you see the greatest need?
We support a lot of different partners. Our focus is the home health and hospice industry. We also support PACE and palliative programs. We’re seeing more incentives as home health starts to evolve with the hospital-at-home programs and things like that; more patients are coming to the homes but they’re also more acute.
You have a greater need for patients to be able to ask questions and get timely answers to prevent rehospitalizations, frustration and complaints as the CAHPS surveys, and all those things appear in Hospice Compare. Everything out there has reviews, right? That’s driving the market. To compete, we partner with the home health and hospice industry leaders so we can help them shine. CareXM is able to help them overcome that triage chaos where they’re interrupted, and we back them up wherever they need the support.
How do you see the hospice care delivery process changing over the next 5 to 10 years and into the future?
I hope to see increased awareness and acceptance of hospice and dying-at-home as the baby boomer population comes out. You’re going to see an increase in patient load, but you’re not going to see a big increase in staffing and resources because of the number of people coming up as baby boomers retire.
We’re going to be smarter. We’re going to have to automate. We’re going to have to figure out better ways for dealing with the things I call the minutia — tasks that don’t matter in terms of caring for the patient directly. I think we’re going to find better ways to automate things like delivering supplies and even refilling medications through apps and other technologies.
Think about how the pharmacies have changed. It used to be, you had to call your doctor and get a physical prescription to take to a brick-and-mortar storefront. Now, you’ve got systems where providers can just log the prescription into the computer and the software sends it directly to the pharmacy. Exploring those different options will help us get a better handle on the simple tasks that need to be done and where those inefficiencies lie.
I think the other thing that we’ll see is a change in ratio of virtual to in-person care, and while I hope we don’t ever lose the actual in-home patient, I think we could add to the experience with telehealth visits. Providers could see their patient for normal, scheduled visits, but when the family has a quick question or concern, there is another means to avoid lapses in care.
It’s hard to triage strictly over the phone, so telehealth offers the patient the support they need in real-time without compromising the quality of the visit. Technology is going to be key in addressing the little details, but I don’t think there’s going to be one big revolution. It’s going to be, “How do we address the little details in the day-to-day and make those tasks more streamlined to support our caregiving workforce.”
Finish this sentence: “The top strategy that home-based care providers should employ in 2022 to best prepare for 2023, is…”
… To assess how unpredictable interruptions and after-hours calls are impacting your case management and staff.
Editor’s note: This interview has been edited for length and clarity.
CareXM is a patient engagement platform that acts as an intelligent, virtual nurse call button that: Knows who to contact when activated. Learn more at carexm.com.
The Voices Series is a sponsored content program featuring leading executives discussing trends, topics and more shaping their industry in a question-and-answer format. For more information on Voices, please contact [email protected].