Dr. Lauren Templeton began her medical career in a surgical internship before transitioning to internal medicine. But in time, her drive to improve patients’ quality of life led her to the hospice and palliative care fields.
Templeton now is a hospice physician consultant at Weatherbee Resources as well as medical director for Texas-based Hendrick Hospice Care. In both of these aspects of her work, she has become focused on physician engagement in the hospice space and the ways providers can maximine the value of their medical staff and partners.
“I remember very clearly thinking about how fellowship does not prepare you for the regulatory burden, understanding and leadership that is required of the hospice physician,” Templeton told Hospice News. “And so that really is what has steered me since then to where I am now. I just am so passionate about hospices deserving to have an engaged hospice physician and to me.”
Hospice News spoke with Templeton on what means to be an engaged hospice physician and what operators can do to foster greater engagement with medical pracitioners in their organizations.
How would you define the term engaged physician? What qualities or characteristics would such a person possess?
Physicians are key in the hospice industry to sustaining quality, compliance, navigating payment-related scrutiny, so that we can continue this incredible thing that we do.
I recognize the physician is honestly just another member of the interdisciplinary group. We’re no more important than spiritual care and nurse aides and all of the other things that we offer, but I really feel that on our shoulders is a requirement to have this regulatory understanding, to lead hospices and take good care of patients.
An engaged hospice physician is always wearing two hats, and that’s truly the lens of how they are providing the most excellent quality care for this patient and how they are maintaining compliance for the hospice that they are working for. Those things are intertwined.
But largely, I think the misconception is that, for you to be a great hospice physician, you do great symptom management or great admissions or great bedside care or advanced care planning. But it’s so much more than that.
It’s understanding the complexities of the differences between the [Medicare] Conditions of Participation and the Conditions for Coverage and being a leader in your quality assurance and program integrity, realizing what your weaknesses are, and helping to strengthen your clinical record documentation.
An engaged hospice physician understands the balance between true quality care of a hospice patient and true compliant care of a hospice.
And how common would you say it is for physicians to be that engaged?
I’m hopeful that that is becoming more of what hospices are looking at as a necessity and looking at as a value. Because unfortunately, with fee-for-service or per diem reimbursement with a Medicare Hospice Benefit, physicians are paid at a different rate. And so there’s a barrier for smaller to medium-sized hospices to get physicians who are able to give them the time that is necessary to be engaged.
But I do think that this is something in the last couple of years, especially with more scrutiny towards what’s related or unrelated [to the terminal diagnosis], and definitely more emphasis on the physician narrative or written certification of terminal illness, that hospices are becoming more aware of how important these administrative roles are for the hospice physician.
So I think it’s growing. There are engaged hospice physicians around the country. But I do also think that there are a lot of hospices out there that don’t understand the lens that I’m offering — all of the implications of leadership from an engaged hospice physician — from quality care to withstanding payment-related scrutiny to true leadership, whether it be infection control policies or helping develop an inpatient unit, and those types of things.
I think there are hospices out there that don’t understand what they’re missing out on in a truly engaged hospice physician.
How can a hospice help create an environment that would enable physicians or encourage physicians to be more engaged?
It comes down to good communication. I hear from a lot of hospice physicians that it wasn’t what they thought it was going to be when they were hired.
So oftentimes, the misperception is, well, we really need you to just come in and run this meeting for a couple of hours every week or every other week. That’s when we’ll help you do the paperwork and sign the orders. And if that expectation is set up for the hospice physician, no wonder they’re not an engaged hospice physician.
So I think a lot of this starts with the hospice, clearly communication and being the leader of the interdisciplinary group. That is so much more than a meeting that occurred every 15 days or more frequently as the patient condition warrants.
I think what hospices need is leadership and quality provision of care and compliant provision of care. That is the key, and then helping those physicians because not every office is going to be able to hire someone who comes with board certification or is fellowship trained. A lot of hospices are having to train up and process doctors on their own, investing in them and their education.
I ask them to figure out how their hospice doctor can do better for them and how much time they spend in orientation with their nursing staff. That varies from weeks to months, six months, and then they have follow-up yearly or more frequently. And then I’ll ask them, “Well, how long was your physician in their orientation?”
And oftentimes, that’s limited to: Here’s where your offices, your parking spot, your badge and your login to your EMR. Physicians don’t get that same investment in the beginning as some of the other members of the team do. So really investing in physician education and clear communication about expectations is key.
And are engaged physicians also making home visits or is that more uncommon?
I really think that depends on the approach of hospices. Because I certainly can be a very engaged hospice physician and not do physician visits. But I think that they’re here.
It comes down to determining what’s available, whether this is going to incur increased scrutiny of our hospice because we’re doing this additional billable service. So I don’t think that visits are required to be an engaged hospice physician. But I think that that is certainly an opportunity that hospice patients are missing out on. Hospices could look to develop that aspect of excellent care.