Hospice, Palliative Care and Hospitals

Cooper Linton, MSHA, MBA

Full Disclosure

I went to publicschool 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 • ACA • ACOs• NC Medicaid

ACOs

• MAPs: –HMO –PPO–FFS

• VBHC

The Market is Going AllBob 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-fears-deadly-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