M&A, utilization trends and legislative action could be major drivers of change in the hospice space, according to Tom Moreland, the newly appointed senior vice president of hospice operations at Traditions Health.

Franklin, Tennessee-headquartered Traditions provides hospice, home health and palliative care as well as consulting services across 18 states. 

Moreland joined the company last month, the next step in a decades-long career in hospice. His previous employers include Aveanna Healthcare (NASDAQ: AVAH), Nextaff, Saint Jude Hospice & Spirit Homecare, Iowa Hospice and Bon Secours Health System, among others.

Hospice News spoke with Moreland about Traditions Health’s hospice priorities, the prevailing tailwinds and headwinds in the space and his outlook for the future.

Can you say a little more about your own background and how you came to the hospice space?

I have kind of a unique story. I’ve been doing it for 25 years. In 1999, after reading a book, I was studying public health at University of Kansas. But I was really struck by the AIDS epidemic.

In the summer of my sophomore year, I went out to San Francisco and lived with 13 men that were dying of AIDs. And as we say in hospice, I kind of got the bug. I had no idea it was going to be a career. I was kind of just doing it to learn to give back and didn’t really know what hospice was, certainly not the modern day Medicare benefit. I really just had a great experience.

I came back, and I started my graduate studies. As I did that, I found a volunteer coordinator position open with Heartland Home Health and Hospice in Kansas City, Missouri. And I thought, well, I volunteered. I had been a caregiver. I’m a CNA in college. So I thought that volunteer coordinator sounded pretty cool. That’s when I learned about the modern day hospice, the Medicare benefit and interdisciplinary teams and all those things. And so I never looked back.

What are your top priorities as you come into this new role?

My role is kind of a mix of a chief cheerleader to the other side of that — being the expert in hospice care for my VPs and administrators and even local leaders, to be a culture champion.

But, strategically, our top priority, along with quality and clients, is growth. Everywhere I have been, I’ve been able to grow the organization, and so that’s definitely a priority.

Looking ahead, what do you see as the biggest opportunities right now for Traditions Health’s hospice program?

I think the foundation is set. We’ve, over the last five years, done a multitude of acquisitions, and we’ve pulled back on that in the last 12 to 18 months, to really build our culture to grow organically.

We have lots of opportunities in our markets. I also think there’s other outside opportunities, like investing in complementary therapies like music and massage and investing in our palliative care department. I do believe palliative care is the future. I think it’s going to be a Medicare benefit. I’d love to see palliative care in more of our markets.

We did some great acquisitions in some great markets, but now we really got to invest in those and in those people.

Another one that’s really important is leadership development, and I know that comes from the top down. We’ve got a new CEO. We have our regional administrators. We’re actually changing that title to an executive director. They are our quarterbacks, and we really have got to invest in those people. They’re going to lead our business at the local level. So we want to do a lot more in leadership development. That’s probably one of our biggest priorities right now.

Conversely, what do you see as the biggest headwinds? How are you combating those?

Wages are outpacing reimbursement. Wages just continue to skyrocket, and we’re really seeing that in our markets.

A hard thing we’re looking at right now is mileage reimbursement and the cost of fuel. It’s really, really tough. You feel like you do a study on wages, and you get competitive; then they just change within the next six months. And then they change again.

We have a great compensation team that looks at that, and we’re making some headway, but that’s always tough.

What do you think are some ways the hospice industry could change in the coming years?

The [Hospice CARE Act] could change the benefit as we know it. We don’t know if it’s going to look at reimbursement and change from a per diem model. I do think a big one is just quality outcomes, value-based. We’re already moving that way. I think there’s going to be more pouring into that, more incentives to be a quality-based provider.

You’re going to continue to see mergers and acquisitions, and some of the largest companies will continue to merge in a lot of our markets and be a really big force that we’ll have to keep up with.

From a utilization standpoint, it went straight up for so many years. It’s around 50%. I think that’s really plateaued, I think you’re gonna hit a ceiling at somewhat close to 60%.