Summary of Hospice and Palliative Care in the Value-Based Era

Summary of "Hospice and Palliative Care in the Value-Based Era" Webinar

This webinar, presented by Lindsey Doak, Director of Research and Education at BerryDunn, explores best practices in hospice and palliative care based on findings from BerryDunn’s extensive 2021 national healthcare-at-home study. The study included 780 home health and 249 hospice agency sites across the U.S., representing a broad spectrum of sizes, regions, and ownership types. The focus of the presentation is on hospice care within the context of value-based care, staffing challenges, operational efficiencies, and patient/family satisfaction.

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Main Ideas and Concepts

• Industry Context and Disruption
  • Healthcare at home (home health, hospice, home care) is the future of healthcare.
  • The industry has faced unprecedented disruption due to COVID-19, staffing shortages, and the shift toward value-based care models.
  • Innovation often emerges at the intersection of diverse functions and perspectives.
• Study Design and Scope
  • Largest study in healthcare at home with 400,000 data points analyzed.
  • Included a national steering committee of clinical, operational, financial, and vendor experts.
  • Hospice data focused on agencies with positive revenue surplus and top family satisfaction scores.
• Staffing and Recruitment Challenges
  • No “magic key” to recruitment; common recruitment sources (employee referrals, online, universities) yield similar results.
  • Benefits packages show little variation across agencies.
  • Advocacy is critical to improve nursing students’ knowledge and perception of home health and hospice care to attract new clinicians.
  • Using non-clinical staff for non-clinical roles (e.g., sales, billing, intake) is effective and does not compromise quality, helping to alleviate clinical staffing shortages.
• Value-Based Care Trends
  • home health is currently under value-based purchasing demonstration; hospice is beginning to experience value-based initiatives.
  • Lessons from home health’s value-based care can inform hospice strategies.

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Best Practices and Operational Insights

• Referral Management
  • Top-performing hospices accept any referral regardless of qualification, leading to higher median length of stay (31 days vs. 23 days) and better family satisfaction.
  • Conversion rates of 70-79% from referral to admission are optimal.
  • Faster admission processes (within 4 hours) correlate with higher family satisfaction and longer length of stay.
  • Dedicated schedulers for start-of-care visits enable quicker admissions and higher satisfaction compared to clinical staff scheduling.
• Caseload Management
  • RN case manager caseloads in top agencies range from 13-18 patients, higher than historical averages (~10).
  • Social worker caseloads are reduced to 13-18 (from historical 23+), improving family satisfaction and enabling better integration of mental health and social determinants of health.
  • Balanced caseloads contribute to healthy median length of stay (~32 days).
• Compensation and Productivity
  • Salary-only pay models for RNs (without extra pay per visit after hours/weekends) are associated with higher family satisfaction and lower clinician burnout.
  • Productivity sweet spot is 4 to 4.5 visits per 8-hour day; too low or too high productivity correlates with lower satisfaction or operational issues.
  • Start-of-care visits optimally take 2.5 to 3 hours for best family satisfaction and profitability balance.
• Complementary Therapies
  • massage therapy (88%) and music therapy (79%) are the most commonly offered complementary therapies in top hospices.
• Intake Process
  • Separate intake processes for home health and hospice referrals increase hospice length of stay by about 8 days, considered a best practice.
• Bereavement Services
  • 60% of top hospices provide bereavement services before death, which improves family satisfaction.
  • 100% conduct bereavement satisfaction surveys to assess and improve services.
• palliative care programs
  • 88% of hospice centers of excellence offer dedicated palliative care programs.
  • Hospices with palliative care programs have longer median lengths of stay (26 days vs. 19 days national average).
  • Palliative care reduces rehospitalization rates, highlighting the importance of care continuity.
  • Most hospices dedicate separate teams for palliative care rather than combining with hospice staff.
  • Nearly all top agencies have formalized screening processes for palliative care patients.
• Technology and Telehealth
  • Adoption of technology is critical to managing staffing shortages and meeting patient needs.
  • Integration of technology with care delivery is essential; lack of communication between tech and care teams reduces satisfaction.
  • Agencies sharing electronic data with other providers have longer length of stay and better continuity of care.
• Employee Engagement and Turnover

Category

Educational

Video