How to Diversify Services Within the Medicare Hospice Benefit

Hospices nationwide have been diversifying their services to include palliative care, PACE, home-based primary care and a host of other business lines. However, some organizations have found success with disease-specific programs reimbursed through the Medicare Hospice Benefit.

A growing number of operators have developed programs tailored to patients with specific diagnoses, providing specialized care tailored to their specific needs. Examples include dementia, heart failure and other cardiac conditions, as well as diseases of the lungs. These are essentially hospice programs that are adapted to these particular populations, and they can be paid for via the Medicare benefit.

“Diagnostic-specific hospice has had tremendous success,” Robin Stawasz, site surveyor for Community Health Accreditation Partner (CHAP) said at the National Hospice and Palliative Care Organization Annual Leadership Conference. “Even if you aren’t ready yet to step outside of the hospice box, diversification is possible within the hospice payment system.”

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These types of programs have proliferated among hospice companies in recent years.

Late last year, Hospice of the Chesapeake unveiled a new dementia care program aimed at providing improved emotional, educational and practical support for patients and their caregivers as their conditions progress. The Maryland-based hospice and palliative care provider has seen a significant increase in demand for dementia care amid a growing population of seniors with Alzheimer’s disease and related conditions across its service region, which spans four counties in the state.

Also in 2024, The Connecticut Hospice Inc. expanded its disease-specific program for dementia patients, dubbed Magnolia Care. The program, which launched three years ago, offers specialized services for patients with dementia-related conditions nearing the end of life. Patients with dementia-related conditions often face more complicated end-of-life trajectories that require caregivers to have a deeper well of supportive resources and knowledge compared to others, The Connecticut Hospice indicated.

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The hospice and palliative care provider VIA Health has long invested in disease-specific programs. Now, the North Carolina-based nonprofit is amplifying its support for congestive heart failure patients.

The organization last summer achieved a Heart Failure Certification from the American Heart Association, which is evaluated in accordance with evidence-based standards designed to ensure high quality care and adherence to clinical practice guidelines. The certification process takes into account six domains: program management, personnel education, patient and caregiver education, care coordination, clinical management and performance improvement.

VIA Health expects that certification will generate referrals from referral partners like cardiology practices, primary care providers and health systems, CMO Dr. Bridget Hiller previously told Hospice News.

“Millions of Americans are going to live with two or more chronic illnesses, and unless we have key disease-specific programs and nationally recognized societies take this as a key priority, we’re going to lose in terms of patients that have certain diseases at the end of life,” Hiller said. “The numbers have continued to grow in terms of building these quality indicators to ensure that heart failure patients get adequate and high-value, quality end-of-life care in their trajectory and get enrolled in hospice and palliative care.”

Stawasz pointed to a hospice provider she had worked with that operated two disease-specific care programs, one for cardiac conditions and one for respiratory illnesses. However, the hospice noted that they were underserving those populations, often because the specialists who work with those patients were not making referrals.

The hospice sought to address this by reaching out to those specialists to discuss their concerns and their reasons for making relatively few referrals. Among other issues, they found that the specialists had questions about the medication regimens hospices often use and pointed to non-hospice services that were still benefiting their patients. They did not want to see those services discontinued, such as short-term cardiac outpatient care, Stawasz said.

In response, the hospice retooled its disease-specific programs to alleviate the specialists’ reservations about making referrals. For example, they began to pay for short-term cardiac outpatient care through the Medicare Hospice Benefit. They also allowed for short-term inpatient stays for IV antibiotics, certain infections and other circumstances.

While this may sound like a financial squeeze for a hospice provider, these practices paid off both in terms of patient outcomes and from a business perspective. Following these interventions, the hospice’s patient census rose to 150, up from 70, Stawasz said. Their budget rose from $2 million to $6 million, and referrals increased by 30%.

“Even within the hospice benefits, you can look at service line diversification. So please be thinking within the hospice payment system as well as outside,” Stawasz said. “Even outside of palliative care, whether it be hospice or non-hospice, there’s a lot of successful diversification opportunities.”

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