If you were to write a book about hospice in 2023, what would you call it? To help answer that question, Hospice News asked the CEOs of nine providers how they would title a book about the state of the field today.
The consistent themes could be summed up as change, challenges and mission. Leaders in the field see tectonic shifts altering the landscape, from new payment models and regulation, to emerging technologies and recruitment and retention strategies, among others.
Amid this transformation, hospices are still contending with workforce pressures, new types of competitors, pandemic and inflationary headwinds, as well as greater public attention to oversight.
Driving their teams forward, CEOs say, is a commitment to the mission of improving the quality of life for terminally ill patients and their families.
These are the stories that these leaders would tell about the work their organizations and care teams perform in communities nationwide. Responses come from the leaders of: Empath Health, Jet Health, St. Croix Hospice, AccentCare, Chapters Health System, Alivia Care, Enhabit, Inc., Bristol Hospice and VITAS Healthcare.
Mission and Movement: Hospice Transformational Change
All of the historical norms, the patient patterns, the alignments of referral sources, the care models, the economic models, the competitive landscape, they’re all changing fundamentally, simultaneously.
Also, more care is going to a home-based environment. A big part of this transformation for us is leveraging our expertise as a home-based care organization at our roots because most hospice care has been provided in the home, but using those roots to now expand home-based services beyond hospice.
– Jonathan Fleece, CEO, Empath Health, a Florida-based nonprofit
What Got Us Here Won’t Get Us There
As we look at new payment models, [the value-based insurance design (VBID) model] becomes more prevalent. There are workforce shortages, and we’re really faced with operating in a different manner. And our patient population even looks a little different in some of the complexities that they have and some of their educational opportunities.
We really look at diversity and inclusion in our patient population and their families, trying to educate them on services. We are really changing our mindsets and the way that we’ve operated in the past, embracing technology and really being open to new creative ideas that would enhance quality of life.
– Stacie Bratcher, CEO, Jet Health, a privately owned company
Here We Go Again
That’s my knee-jerk answer, because it just seems like so much of this is cyclical. We’ve heard from the [Medicare Payment Advisory Commission (MedPAC)] on the 20% payment cap reduction. We’ve heard that year after year.
If we look at some of the decks and slide presentations on the Medicare Advantage carve-in, going back to 2018, it’s the same information, and we’re still talking about impacting change. But I wish we just knew what the path was going to be. Is Medicare Advantage going to be the path?
We want to make a difference. We want to impact the lives of not just our patients, families, not just the other caregivers, but our team members. Our team members need to be cared for because they’re giving everything they have to these patients and families, and it’s emotional and impactful.
– Heath Bartness, CEO, St. Croix Hospice, a portfolio company of H.I.G. Capital
One of This Country’s Greatest Benefits
Hospice is an incredible service and a tremendous benefit, and maybe the subtitle would be, “Until You Experience It, You Really Can’t Feel It.” When you have hospice working the way it’s supposed to, what it does for families, as well as the people at the end of life, is just incredible.
I got to personally experience it myself this year, as my mother passed on our hospice services. And it was just an incredible thing.
There’s the problem of how hard it is to get people into hospice. The system does not naturally want to put people into the hospice benefit. I was lucky to be a knowledgeable consumer and have a supportive set of physician practices that could kind of make the right referrals.
But once you are in there, and you watch everything from the way that social workers and the chaplains engage with the families, the nurses appropriately engage with the families, you see how you can turn what is probably one of the most terrifying human experiences into something manageable.
– Steve Rodgers,. CEO, AccentCare, a portfolio company of Advent International
The Hospice Calling: Why a 40-Year-Old Benefit Is the Secret to the Future of American Health Care
What we’ve articulated to our team over time is that the American health care landscape has been built on fee-for-service — fragmented, parceled out, non-communicative, and very, very disjointed. It’s almost an every-man-for-themselves element. And if you look at what is now radical and innovative and groundbreaking, it’s this notion of capitated, person-centered, community-based care, which is what all hospice has always been.
Now you have pundits and think tankers saying the only way forward is capitated amounts based on quality, ideally driven at a low-cost setting, and wow, how radical if we incorporated social determinants and person-centered care. All we can do is kind of laugh and say, “Well, it took you 40 years to realize we’ve been here under your nose the whole time.”
You’re seeing it right now; hospice is getting opportunities in [Accountable Care Organization (ACO)] environments, in commercial and private insurance opportunities. Acute care and private equity, everybody’s catching on, but we’ve kind of been the best-kept secret and the future of what this all has to be.
– Andrew Molosky, CEO, Chapters Health System, a nonprofit
We’re Still Standing
One of the things that concerned me was just looking at the overall utilization of hospice, taking a step back a couple of percentage points after years and years of going up. We are seeing some slippage there.
Also, as more value-based care is happening, many patients are being cared for in what we call a substitute-competition model, where hospice is not really a good thing in the eyes of those that are at risk for the total cost of care. That’s something I’m looking at very carefully.
And when you just look at the rate of inflation and look at the rate of salary increase that we had this past year, a lot of us still have pandemic-related expenses. You put all that together, and it really is creating some margin compression because expenses continue to go up.
We’ve been so short-staffed. It’s really been very challenging. I think it’s going to be a few years of real scarcity in our bedside people.
Even our billing is harder. The amount of work you have to do to collect money with Medicare has grown. And then in Florida a few years ago, our state sent all the Medicaid dollars to managed care companies.
– Susan Ponder-Stansel, CEO, Alivia Care, a nonprofit
It was a year full of challenges related to staffing, volumes, business development – you name it. But we’re working to create “Stability” in 2023 by continuing to provide the best care to our patients and investing in the well-being of our employees.
– Barbara Jacobsmeyer, CEO, Enhabit, Inc. (NYSE: EHAB)
Back to Basics
Everyone wants to create some overarching strategy to do something really creative and unique. But sometimes, I heard from my mentor a long time ago, if you do something really excellent and you do it consistently, that’s what you’re looking for.
When you’re focused on the right things — putting people No. 1, so being a people-based business — and you do that right, you’ll be just fine.
– Alex Mauricio, CEO, Bristol Hospice, a portfolio company of Webster Equity Partners
The Power of Purpose
For all providers, whether you’re a team member providing that care or if you’re a leader that is helping to create an environment to attract and retain those folks, the hospice benefit has never been more needed out in the community.
You really have to believe in the purpose of what you were doing. The mission of the hospice benefit is the thing I think carried everyone who’s working the space today. That fundamental purpose, the outcomes, the difference it’s making in this country is the thing that’s kept people here. Otherwise, you have plenty of alternatives to figure out what else you want to do.
A purpose-driven vision is what gets everybody through the tough times.
– Nick Westfall, CEO, VITAS Healthcare, a subsidiary of Chemed Corp. (NYSE: CHEM)