Today’s hospice leaders need to take a wide view into the range of challenges facing their interdisciplinary care teams, according to Dr. Andrew Mayo, chief medical officer at St. Croix Hospice.

Mayo joined St. Croix Hospice in 2014 as an associate medical director. The Minnesota-headquartered hospice provider is a portfolio company of the private equity firm H.I.G. Capital. Mayo has focused on geriatric care for 17 years, completing a residency in family practice at Bethesda St. Joe’s Hospital in St. Paul, Minnesota and going on to practice in St. Croix Falls, Wisconsin.

He recently sat down in a Hospice News Elevate podcast to discuss what pulls workers towards the end-of-life care space — and the factors that are leading them away. While competitive compensation and work-life balance are important priorities for hospice workers, organizational culture is one of the most significant retention factors, Mayo stated.

“What’s probably one of the biggest challenges for hospice and health care in general is hiring and maintaining clinicians. That’s where the rubber hits the road,” he told Hospice News during the podcast. “One of the most important things is culture. As you grow as a hospice, I think [it’s about] paying particular attention to culture, because people want to work for an entity, a health care provider that has their heart in the right place. That goes a long way for retaining employees … Maintaining that culture is an easy thing to say, but a very difficult thing to do.”

In terms of recruitment, hospices’ hiring strategies should speak to the collaborative components of care delivery and the meaningful impacts that an interdisciplinary team approach can have, Mayo said. Interdisciplinary team collaboration is among the reasons why many professionals enter and stay in the hospice field, particularly those who aim to provide goal-concordant care at a critical time in patients’ lives, he indicated.

Mayo is descended from generations of clinicians who have helped shape the interdisciplinary team approach. His great, great grandfather, Dr. William Worrall Mayo, immigrated to Minnesota from England in the 1840s, later establishing a family practice. His sons, William J. and Charles H. Mayo, went on to launch the Mayo Clinic, which was among the health care providers pioneering multidisciplinary, person-centered care.

“That team approach I think is really extraordinary for what we do in hospice. It really struck a chord for me,” Mayo told Hospice News during the podcast. “My great grandfather always said the best interest of the patient is the only interest to be considered. That’s something we always have to keep in mind in hospice — to do the right thing first and foremost for a patient and their family, yet keeping the hospice benefit requirements in mind as well. It’s sometimes a delicate balance and a challenge.”

Hospices need strong communication and engagement avenues among interdisciplinary teams to help them contend with issues impacting care delivery such as workforce shortages amid rising demand, Mayo indicated.

Clinical teams also need to be well-versed in ways to address the physical, emotional and psychosocial needs among patients with increasingly diverse comorbid conditions, he added. Cancer has been one of the most common conditions among patients since the Medicare Hospice Benefit was established roughly 40 years ago. But hospice patient populations have increasingly had other diagnoses such as heart, kidney and lung diseases and Alzheimer’s and dementia conditions, changing not only the mix of treatments but also the interdisciplinary care approaches, according to Mayo.

Alongside these have come regulatory changes and clinical capacity constraints, creating a difficult landscape for interdisciplinary hospice care teams, Mayo stated.

“It’s sort of a juxtaposition of more demand and diverse conditions among patients alongside these sorts of regulatory changes coming as well,” Mayo said. “These are all important pieces to think about when you think about end-of-life care delivery. We are certainly seeing increased oversight and audits throughout the hospice world.”

Hospices need to have internal processes to ensure compliant care delivery practices, including having robust quality assurance reviews and ongoing documentation review processes, Mayo indicated.

Hospices have pivoted their compliance strategies in response to increased auditing activity as regulators seek to weed out malfeasance and improve quality and program integrity. Regulatory oversight in the hospice industry has ramped up amid fraudulent activity, specifically instances occurring in four hotbed states of Arizona, California, Nevada and Texas.

The regulatory trends may create mounting pressure on interdisciplinary hospice teams, according to Mayo.

“We want to be good stewards of the hospice benefit, but just as importantly we want to provide great care to patients,” Mayo said. “What’s happening is we’re seeing very wide nets being cast, and unfortunately it creates a significant amount of time and personnel dedicated to addressing these audits. From a clinician standpoint, unfortunately it’s time that could be better spent on caring for patients, versus trying to address the concerns of a widely cast net [and] finding that balance between the program integrity and the bedside time and making sure that both of those are in check.”

Technology integration may be among the keys to easing operational pressures while building a sustainable interdisciplinary care team, according to Mayo. More hospices are leveraging technology that helps to reduce documentation burdens on staff while also flagging errors. Predictive data analytic software has also come to the forefront, which can help clinical teams understand where the largest areas of patient needs exist, he stated.

Hospice leaders can anticipate that technology utilization will play an increasingly important role in their retention efforts, Mayo stated.

“What we’re going to see more and more of is increased use of technology within hospice,” he said during the Hospice News podcast. “For challenges like dealing with work-life balance, the technology component of things makes sure that they’re able to have less frustrations in charting and being able to do that smoothly at the bedside. It’s technologies … that help us to recognize patient transitions earlier so we can help devise care plans.”