Hospice, Palliative Care
and Hospitals
Cooper Linton, MSHA, MBA
Full Disclosure
I went to public
school here.
Dying is Expensive
“Health care expenditures in the United States
exceeded $2 trillion in 2006 and are expected to
rise rapidly during the next decade. A
disproportionate share is spent at the end of life
(EOL). Thirty percent of Medicare expenditures are
attributable to 5% of beneficiaries who die each
year; about one-third of the expenditures in the last
year of life is spent in the last month.”
http://archinte.jamanetwork.com/article.aspx?articleid=414825
Dying is REALLY Expensive
“In 2011, Medicare spending reached close
to $554 billion, which amounted to 21
percent of the total spent on U.S. health
care in that year. Of that $554 billion,
Medicare spent 28 percent, or about $170
billion, on patients’ last six months of life. ”
-- June 03, 2013, End-of-Life Care Constitutes Third Rail of U.S. Health Care Policy
Debate, by Susan Pasternak / The Medicare NewsGroup
Remember the “good old days?”
Current Model
Hospital = Referral Source
Hospice = Referral destination
Palliative care = fancy word
for hospice
Alphabet Soup
• MAPs:
• ACA
• ACOs
• NC Medicaid
ACOs
–HMO
–PPO
–FFS
• VBHC
The Market is Going All
Bob Dylan on Us!
• The times, they are a changing…
• We are now being charged with managing
risk and cost.
• The roles and relationships between us all,
they are a-changing.
Managing Patients =
Reducing Risk =
Containing Cost of Care
“How we pay is how we play.”
--Howard Houser, PhD.
Stuck In The Middle?
Hospice
The only proven risk management
model for patient care and cost
during the most expensive period
of a person’s medical life.
Palliative Care
The most misunderstood, poorly
accessed, improperly motivated,
cost effective program that
consistently saves money at end of
life, but doesn’t get to keep any of it.
Hmm…?
Two Types of Data
• You need data FROM your partners to
quantify how you work together.
– What are the outcomes of your relationships
in real, local, painfully honest numbers?
• You need data ABOUT your partners.
– What are their real, local, painfully honest
numbers about using hospice, home health,
etc?
Definition of Quality is Changing
• Hospice has experience-based
outcomes.
–FEHC scores
–HIS data set
–Plus: “Our patients love us”
• Palliative care doesn’t have SQUAT!
Data You Need
• How well does (insert Hospice and/or
palliative care organization here) avoid
readmissions/emergent care?
• How quickly can the provider assist with
following patients in the community?
• Can they offer Inpatient Hospice care?
Hospice/Palliative Care
• How does hospice/palliative care partner
with nursing homes to keep their
readmissions down?
• What about assisted living/adult care
homes?
• From what setting are patients referred?
You Can’t Save It
AFTER You Spend It
• Median length of service in hospice is less
than 3 weeks
• If most of the money is spent in the last 26
weeks of life, we are 23 weeks too late.
Hint: the key is proper identification and use
of hospice and palliative care services
Just Go With Me on This…
Let’s buy a car together.
“Choice” or “Ignorant Selection”
http://smallbusiness.chron.com/make-profit-used-car-business-486.html
Patient Perspective
• Expertise in pain and symptom
management
• Highest quality measures
• Training of staff
• Depth and breadth of services
•
Risk/Cost Perspective
• Access to inpatient hospice beds
• Increased ability to deal with pain or
symptom management
• Access to full-time, board certified
physicians
• Lower readmission rates
• Lower use of emergent care
•
New Model
ACOs, hospitals, hospice/palliative
care, physicians, et al., sit down at
table as partners to discuss how to
manage patients in the lowest acuity.
http://www.rawstory.com/rs/2012/12/21/europol-fearsdeadly-turf-wars-as-biker-gangs-arrive-in-europe/
New Model
Discharge planners/Social workers become
“matchmakers” between patient/family
needs and best available providers.
Patients are informed quantitatively and
choices are respected.
Hospice and palliative care
become “patient care
managers, and therefore, risk
managers” for individuals during
the most expensive period of
their “medical life”.
Questions
• Thoughts
• Suggestions
• Random notions about Alabama