“Palliative medicine saved my life.” These words from his daughter Rose inspired Dr. David Thimons to launch a new palliative care company.
Rose is a survivor of bone cancer. The result of her family’s ordeal is the Rose Program, a for-profit company that provides palliative care primarily in nursing homes, with plans to expand into community-based services.
Thimons early in his career was a nursing home geriatrician. But his daughter’s cancer experience led him to become palliative care board certified, eventually becoming chief medical officer of the national palliative medicine company Aspire.
Hospice News sat down with Thimons to discuss the origins of the Rose program, its sustainable care model and plans for the future.
Can you give me a sense of the size of the business?
We have about 140 people, full-time W-2 employees. That is how we can control clinical quality. We have a large team. We are 100% nurse practitioners on the ground in facilities, seeing patients eye to eye, talking to patients and families. We should double in the next 12 months at least, and that’s kind of what the structure of the company looks like.
Is there anything more you could say about the care model?
There’s two areas where someone might get confused. What’s the difference between you and hospice? And number two is: Don’t the regular docs in the building do that work? So maybe we could address those two, and by addressing those two, it’ll explain our care model.
I’ve been a hospice medical director for a lot of companies. I love hospice … no question about it. But hospice is for patients in the last six months of life, a doctor has to certify a statement that says if disease runs its expected course, life expectancy is six months or less, then the patient and family’s goals and values have to be in alignment with comfort care.
In order to be eligible for palliative medicine, you have to have advanced illness. That’s it. I had a mentor once tell me one of the founders at Aspire Health used to say, “If palliative medicine were a pill, everyone with advanced illness would be on it.” So, if you look at palliative medicine as a whole pie, and hospice is just one small slice of it.
Palliative medicine works as a great transition and funnel to hospice because, by having conversations earlier, and by being honest with patients and families, and communicating, patients are much more open to the concept of hospice when they meet criteria.
And your second question?
The second question is, “Don’t the docs in the building do that? Why the heck are you needed?
I created this program to focus on two very specific things. The first is the creation of a life plan around every terminal illness. What does that mean? I want to flip palliative medicine today in the country as crisis care, and I want palliative medicine to prevent a crisis from ever happening by proper information and education and communication.
You create this life plan, which is not a one-time document. It’s a living document that changes as a patient changes. We spell this out very clearly: Patient does not want further treatment. Patient does not want to go to the hospital. When they meet hospice criteria, they’ll go to hospice.
The second thing we do is aggressive symptom management. We have a full checklist of every palliative distressing symptom related to the diagnosis. We focus aggressively on all those distressive symptoms, and the docs just don’t have the time to do it all. They’re monitoring labs and reviewing meds and treating the underlying illness. But even if they’re the smartest doc on earth, they don’t have time to do all that.
We want to stay in our swim lane, not step on great physicians’ toes, but add value where value needs to be added, and that is the quality of life of the patient.
How do you determine eligibility for the patients?
Straight by Medicare guidelines. Medicare says patients with dementia, oxygen dependency, heart failure, COPD, stage-four or -five kidney disease, end-stage liver disease, metastatic cancer, et cetera, all need palliative. These are the patients that are going to get our service. We’re not going to wait for a doctor to write a consult, because that’s part of a failing system. We’re going to follow the guidelines.
These are the highest cost patients to the healthcare system. They have the most suffering, and bringing them on based on data at the right time can help with both of those. We’ve been part of an [Accountable Care Organization] for four years. We’ve been able to demonstrate a 30% total reduction in cost of care. Patients go to the hospital less. They take fewer medicines, have better patient and family satisfaction.
How do you connect with the facilities you partner with?
We started by knocking on doors. But now we have about 13,000 patients on service.
There’s a lot of word of mouth. People call and ask for us. We’re at national conferences presenting, talking to chains. We still do some good old-fashioned calling and door knocking. it gets a lot easier once you get to be known and meet a lot of these right people.
Could you talk a little bit about the business model for the Rose program? Is it strictly Medicare fee for service reimbursement?
We created a model where we have a positive margin on fee-for-service. Not huge, but we can pay the bills and make a dollar. We have a sustainable program.
The plan is now that we’re collecting data, improving our value. We want to get into some [per member-per month) shared savings contracting with payers and groups.
What are the next steps for the Rose program? How do you plan to grow from here?
Our mission statement is to redefine what palliative medicine means across America and make it available to all patients in need. Today, we see patients across Florida, Pennsylvania and Ohio. In October, we open North Carolina. In December, we open in Delaware. In January and February, we opened Virginia and Georgia.
In 2027, I’d like to be along the eastern seaboard. I’d like to grow into other states where there’s need. I am in the process of creating a home-based program because I think patients in the home have more suffering. At least in a nursing home, you have a nurse or someone there looking at you. There’s a lot of patients in the home who can’t get to the restroom. They can’t get to the refrigerator. They can’t get their medicine. It’s heartbreaking.
Do you have a time frame for launching the community-based program?
We’ll launch on the first of the year. We have it almost set. We’re going to pilot it in some of our facilities before the end of 2026, and in 2027, we’re going to launch it globally. I think that’s where we’re going to partner with hospice even more.
