Amid a rash of financial headwinds, Forks Community Hospital is investing in a palliative care program. 

This decision came after physicians at the Washington state-based hospital noticed a troubling trend: People with chronic conditions often come to the emergency room in a crisis because no one provides the care they need in the home setting.

The hospital is up against many of the same financial constraints that others across the country are currently navigating. And those problems are amplified in the rural town of Forks; earlier this year, the hospital had a $512,000 revenue shortfall.

Nevertheless, Forks is all-in on palliative care.

“Having people admitted through the ER at the end of their life, when they would love to pass at home, is really sad,” Sarah Fletcher, the hospital’s clinical case manager, told Palliative Care News.

When Fletcher started her job, she set out to solve the problem with limited resources. With guidance from the Washington State Rural Palliative Care Initiative, she has set in motion plans to launch a palliative care program at the hospital.

The program will start serving patients on Sept. 1, 2024, providing in-home palliative care services to eligible patients who also receive primary care through the hospital. The hospital serves a population of around 10,000 people, most from the western portion of the roughly 80-mile-wide Clallam County.

It may seem like an ambitious plan for a community hospital dealing with a significant revenue shortfall. But according to Fletcher, the program is being launched not despite those problems, but because of them.

Most of the hospital’s revenue shortfall comes from its long-term care facility — a 20-bed outfit. In a community in which 52% of the population struggle to afford basic necessities, patients can’t always pay for their stay, and the hospital eats that cost.

Fletcher expects that the new program can ease some of that financial burden while reducing readmission rates and frequent ER visits.

Some research supports that prediction. Atlantic General Hospital in Maryland saw costs fall by almost a third after implementing a similar program, according to a 2017 report in Mathematica Policy Research.

Currently, people in Forks who need in-home care for their chronic conditions rely on a home health company based in the town of Port Angeles, more than 50 miles away. Another caregiving agency in the area serves patients on Medicaid or Medicare, but their availability is limited. According to Fletcher, right now, there’s a two-month wait to see a caregiver through that service.

Offering palliative care services through a hospital with tight finances is challenging because private insurance, Medicare and Medicaid do not always fully cover those services. To get around that problem, the Forks program will include a chronic care management program, which serves patients with two or more chronic illnesses, and is mostly covered by insurance.

Chronic care management patients and services largely overlap with those in palliative care. The program will also offer transitional care, which helps patients transition from in-patient to out-patient care.

Patients in the program will be served by their primary care physician, a nurse case manager, and EMTs. According to Fletcher, Medicare will cover 80% of services provided through the chronic care management program. Medicaid and some private insurance plans will cover the remaining 20% copay.

And those without coverage who are unable to afford the copay can tap into the hospital’s charity care program.

The palliative care program will launch using only existing staff, but hospital leaders plan to expand it during the next four years. Eventually, they will add community health workers, interpreters for Spanish and Mam-speaking members of the community, and telehealth capabilities. Mam is a language spoken predominantly in Guatemala.

They recently applied for a federal grant that would enable them to expand services much sooner to include a designated vehicle for food and medication deliveries and a bed lift for patients to borrow while they await a permanent setup.

The need is clear, according to Fletcher.

“I can think of 30 people off the top of my head who would benefit from this program right now,” Fletcher said. “And when I talk to our primary care providers, they want to know how soon they can start referring.”