The workforce shortage and value-based care will shape the future of hospice, according to some providers.

The health care reimbursement environment is moving towards significant change. The U.S. Centers for Medicare & Medicaid Services (CMS) has signaled its intention to align every Medicare beneficiary with a value-based payment system by 2030.

To keep pace, hospice providers must start preparing now, according to Phil Ward, president and CEO of Community Hospice of Northeast Florida.

We’re implementing quality movement projects now. So that when these changes come we’re not taken by surprise,” Ward said at the National Hospice and Palliative Care Organization (NHPCO) Annual Leadership Conference. “We’re ready for it, and then hopefully when we get there, we providers hold ourselves accountable.”

The most likely pathways to value-based payment going forward are Medicare Advantage and Accountable Care Organization (ACO) relationships, as well as a growing number of disease-specific model demonstrations that incorporate elements of palliative care. Examples include the Kidney Care Choices Model, the Guiding an Improved Dementia Experience (GUIDE) Model and the Enhancing Oncology Model.

The second major force that could mold the industry’s future is the staffing shortage, Leigh Anderson, medical director for Our Hospice of Indiana, said during the NHPCO conference. This includes issues like turnover, nurse-to-patient ratios and health care worker burnout, she said.

“We have been prioritizing recruitment and retention, and a lot of what that’s looked like for us has been flexibility. So maybe our nurses have patients instead of five. If that’s their preference, being a little bit looser with [paid time off] … just allowing my team to do what they need to do to maintain work-life balance,” Anderson said. “Hospice is a great space in health care. We can really compete in flexibility, whereas other areas of health care can’t as much.”