The Value of Hospice-Emergency Department Collaboration

Fostering greater collaboration between hospices and hospital emergency departments can help reduce health care costs, generate revenue and improve patient outcomes.

Reducing hospitalizations and emergency department (ED) visits are key goals for many health care stakeholders, particularly those that operate within a value-based environment. For providers, seniors are a crucial population due to their high rates of utilization. Nearly 40 million seniors visit the ED annually, according to the Institute for Healthcare Policy and Innovation at the University of Michigan.

For patients, however, the ED may not always be the best option, Rebeka Malloy, director of clinical engagement for Compassion and Choices, said at the National Hospice and Palliative Care Organization’s (NHPCO) Virtual Interdisciplinary Conference.


“Emergency departments aren’t always equipped to meet the demand brought on by chronic illness, an aging population, rising mental health needs and those without access to other primary care options,” Malloy said. “They are also not equipped to manage the increasing number of people that come in during their final phase of life.”

Due to the ways EDs function — with the motto “triage, resuscitate, stabilize and transfer” — staff often wait until the patient is actively dying to contact hospice or palliative care, according to Malloy. However, integration of those services into ED workflows can make a difference, she said at the conference.

This kind of integration can come in the form of three different models, Malloy indicated. These are primary palliative care, consulting palliative care and embedded palliative care specialists in the ED.


‘We have to remember that not all hospitals have palliative care, or that palliative care teams may not have the bandwidth to attend to patients in the emergency department,” Malloy said. “It is crucial for emergency department staff to be trained to provide basic palliative care, whether it be pain and symptom management, or initiation of goals-of-care discussions, recognition of signs of impending death. We need to equip them with the skills and the abilities to be able to provide basic primary palliative care.”

Some health systems have been partnering with hospice and palliative care providers to expedite referrals to hospice, coordinate care and avoid unnecessary admissions, Emily Bowers, senior health services researcher with Advocate Health, said at the NHPCO conference. Advocate operates under the Atrium Health brand in some markets.

The health system during the pandemic began collaborating with the nonprofit hospice VIA Health Partners to help reduce capacity strains, according to Bowers. The collaboration allowed the health system to expand access to hospice and prevent avoidable admissions without having to build its own program from scratch.

“One of the very first things that a hospice or palliative care organization can do before we think about reaching out to a busy hospital or the ED team is to understand the immense value that your organization can bring to the hospital,” Bowers said “We know that we bring in its value to patients and families as part of our service, but it’s also important to know how creating different programs and projects and workflows for the ED can really have a positive impact on on their bottom line.”

During the first six months of this collaboration, Advocate and VIA saw 30 easy admissions to hospice, which saved the hospital more than 200 patient days, as well as $224,000 in inpatient costs, according to Dr. Bridget Hiller, CMO for VIA Health Partners. They also prevented 10 readmissions.

Those patients received an aggregated 975 days of care from VIA Health Partners, which also generated hundreds of thousands of dollars in revenue, Hiller said. The program is now being scaled across all Atrium Health hospitals.

Four factors were key to the program’s success, according to Hiller. First was the 24/7 availability of hospice and palliative care, as well as visibility for their staff in the ED. New elements also to be incorporated into the ED’s workflows, including clearly defined responsibilities for each member of the interdisciplinary team.

“Collaboration was truly key to the success of this, and it really enhanced the partnerships that we had with the EDI and also enhanced our partnerships with the hospital as well,” Hiller said at the conference. “Because of that reason, we were able to scale this to other hospitals.”

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