Some hospices have delved deeper into service diversification to improve timely access and expand their patient reach, while others remain focused on end-of-life care delivery. The decision to launch into new service realms can come with a range of operational and reimbursement questions.
Among the keys to diversifying services is establishing a business infrastructure that allows for innovative growth based on communities’ needs, according to Leslie Campbell, COO of Touchstone Communities. The San Antonio, Texas-headquartered company provides hospice, home health, veterans services, assisted living and skilled nursing services.
Touchstone Communities has provided care since 1994 and is currently considering the launch of a new behavioral health service line, Campbell indicated. Being nimble enough for diversification involves recognizing the staffing and billing considerations involved, among a host of other business and care delivery aspects, she stated.
“[There’s the paradigm shift required by the clinicians,” Campbell told Hospice News at the Continuum conference in Washington D.C. “We’ve learned that it’s really hard to get your head around the numbers and understand the mechanics of the [care] model. They don’t understand the big picture and the reimbursement world. There’s a necessity to make sure those closest to the bedside of the patient understand the ‘why’ behind some of these shifts.”
Hospice leaders need to ensure that both back-office administrative and interdisciplinary teams are educated on how business growth impacts them, particularly when it comes to quality and compliance across the care continuum, Campbell stated.
Regulatory obstacles can arise if the overall workforce does not grasp the full scope of compliance across different business lines, she said. Remedying these issues takes intentional staff training and onboarding for both back-office and interdisciplinary teams.
“We’ve had some regulatory challenges because of caregivers in these other business lines not understanding the regulatory requirements,” Campbell said. “You’re operating two business models under the same roof, with this subset of your population that adheres to these rules, and this subset of your population that adheres to another set of rules. There is an appropriate level of understanding of each of these models that goes to care. Err on the side of over communication throughout the process, because there’s a lot of heavy lifting that goes along at the back office, then at the communities, and then in the post-acute space in general.”
Regardless of whether hospices choose to explore service diversification, their operations have seen significant changes since the establishment of the Medicare Hospice Benefit – a trend largely driven by patient preferences and needs, according to Empath Health CEO Jonathan Fleece.
Launched nearly 45 years ago, Empath Health is among the largest hospice providers nationwide and operates 17 affiliates and two philanthropic foundations. The hospice provider also offers home health, palliative and primary care, adult day services and Programs of All-Inclusive Care for the Elderly (PACE), among other services.
Hospices have taken varied approaches to end-of-life care delivery, and that diversity is a key to addressing patients’ physical, emotional, psychosocial and spiritual needs, Fleece indicated.
Finding innovative, creative ways to deliver quality services is a significant part of hospice care delivery, he stated. Today’s hospice leaders need a wide lens around what end-of-life, serious and advanced illness care can look like for patients with varying needs, Fleece said. This approach can help drive their growth strategies and ensure thoughtful consideration around the operational, technical and compliance aspects involved, he added.
“[We should] not be pigeon-holed into what holistic, interdisciplinary, end-of-life, serious, advanced illness care looks like,” Fleece told Hospice News at the Continuum conference. “It can sometimes help with that paradigm shift, because we get so stuck sometimes in our siloed way of thinking and around revenue, benefits, Conditions of Participation and how the EMRs will dictate us going down certain clinical pathways, that we forget the bigger picture that I think the founders of end-of-life care really envision for what our obligations are.”