Archive for the ‘Hospice’ Category

MSKCC Integrated Case Management Enhances Efficiency, But Never At Patients’ Expense

August 29th, 2017 by Patricia Donovan

MSKCC’s service-based interdisciplinary team adheres to the four C’s of team-based care.

With a reputation synonymous with state-of-the-art cancer care, Memorial Sloan Kettering Cancer Center (MSKCC) shouldn’t have much to prove.

But like most healthcare providers, with the dawn of value-based care, MSKCC began to face tougher competition from hospitals with managed care contracts and limited networks. To attract and retain payors, MSKCC had to demonstrate that its care was both cost-effective and cost-efficient.

“Under managed care, you had to be able to prove your worth,” explains Laura Ostrowsky, MSKCC’s director of case management. “And worth was more than just best care, it was best care in a quality-effective manner.”

To accomplish this, MSKCC adopted a multidisciplinary, team-based care coordination approach, Ms. Ostrowsky explained during Integrated Case Management: A New Approach to Transition Planning, an August 2017 webinar now available as an on-demand rebroadcast.

Transition planning used to be referred to as discharge planning, she noted.

Integrated case management is at the heart of MSKCC’s service-based strategy, with MSKCC case managers  assigned by service. “That means that if a case manager is based on the tenth floor, which houses breast and GYN services, and one of those patients is in the ICU, they’re still being followed by the breast or GYN case manager.”

The variety of care settings is one of a half dozen reasons integrated case management is necessary, Ms. Ostrowsky added.

Communication among all team members is key, she continued, outlining the four ‘C’s’ of team-based care—so much so that some scripting has been created to keep all team members on message with patients.

However, a commitment to standards in communication and other areas should never override a patient’s need. “The clinical issues should always take priority,” Ms. Ostrowsky emphasized.

A day in the life of an MSKCC inpatient integrated case manager runs the gamut from reviewing and assessing new patients to orchestrating transition planning. “Our patients go out with all kinds of services, from infusion care to home chemotherapy to wound VACs.” Some patients are transferred to post-acute facilities, while others face end-of-life issues that include hospice care, which could be inpatient or home.

Hospice care was one area of focus for MSKCC—in particular, getting providers to speak frankly with patients about hospice and incorporating those services earlier on in the patient’s diagnosis when appropriate, both of which required a cultural shift. “Our patients didn’t come to Memorial to be told that there’s nothing that we can do for them,” she explained. “And our doctors didn’t come to work at Memorial to send people to hospice. They came here to cure cancer.”

In taking a closer look at end-of-life services, Ms. Ostrowsky found that physicians tended to refer to hospice later than she hoped that they would. “I wanted to really look at our length of stay in hospice as a way of identifying the timeliness of referral.” A longer hospice stay allows the patient to form relationships with their hospice caretakers rather than feeling abandoned and “left to die,” concluded Ms. Ostrowsky.

By placing case managers in inpatient areas and encouraging key case management-provider conversations that she shared during the program, MSKCC improved hospice referral timeliness and grew hospice length of stay. In turn, these quality improvements correlated with higher patient (and family) satisfaction.

Integrated case managers have also been key in identifying patients who can benefit from LTACH services and moving them there sooner, she added. “We can decrease length of stay within the hospital and get [patients] that kind of focused care that they need sooner.”

Listen to Laura Ostrowky describe the surprise question that can improve timeliness of hospice referrals.

6 Population Health Strategies to Set Stage for Physician Reimbursement

May 12th, 2016 by Patricia Donovan

Robert Fortini, PNP

A team-based, top-of-license approach is key to population health success, says Robert Fortini, PNP, Bon Secours Medical Group chief clinical officer.

In the last six years, Bon Secours Medical Group (BSMG) has deployed a half-dozen population health strategies as groundwork for its Next Generation Healthcare offering. Here, Robert Fortini, PNP, BSMG chief clinical officer, identifies the tactics his organization leverages to effect health behavior change.

The specific population health strategies Bon Secours has deployed over the last six years start with the patient-centered medical home (PCMH) concept. I’m an avid believer in the concept of a team of professionals working together, along with that ‘top of license’ aspect, where it’s not just the sole domain of the independent ‘cowboy’ physician taking care of the patients. It’s pharmacists, nurses, social workers, and registered dietitians. It’s the entire team, with everyone having a vested responsibility for practicing to the top of his or her license.

Next, access is huge. It is ridiculous to think we can manage chronic disease in four 15-minute visits a year scheduled between 8 a.m. and 5 p.m. Monday through Friday, while closing at lunchtime. It’s absolutely ludicrous. We are blowing that up by opening weekends and evenings and using technology to expand access, which is critical to affecting that behavioral change.

Third, know your population. Identifying effectively those who are most at risk with advanced analytics to make your efforts more efficient is very important.

Next is managed care contracting—aggressively coming to the table with our payors to help guide the conversations and craft the contracts and benefit designs that are attainable and achievable. That has been a new experience for Bon Secours in the last five years in particular. We have a CMS-based Medicare Shared Savings Program (MSSP) Accountable Care Organization (ACO) covering about 30,000 attributed lives. We also have a number of commercial ACO-type contractual relationships with our commercial payors.

Fifth on the list: aggressive growth for palliative and hospice. We have invested very significantly in management of advanced illness that occurs at the end of life. The Medicare numbers around that are staggering: 40 percent of Medicare spend occurs in the last two years of life, and the pain, suffering, and emotional angst that occurs for patients and their families is incredible. Investing in the resources necessary to manage that effectively has been our strategic initiative at Bon Secours. We have a very large, well-versed palliative program that provides inpatient, outpatient and even home-based palliative services. And our hospice agency, which I am responsible for in addition to our medical group, has quadrupled in size in the last two years alone.

Then, finally, we manage the white space with powered care coordination, which includes health promotion, chronic disease management, care transition management, and more.

Source: Physician Reimbursement in 2016: 4 Billable Medicare Events to Maximize Care Management Revenue and Results

http://hin.3dcartstores.com/Physician-Reimbursement-in-2016-4-Billable-Medicare-Events-to-Maximize-Care-Management-Revenue-and-Results_p_5143.html

Physician Reimbursement in 2016: 4 Billable Medicare Events to Maximize Care Management Revenue and Results details the ways in which Bon Secours Medical Group (BSMG) leverages a team-based care approach, expanded care access and technology to capitalize on four Medicare billing events: transitional care management, chronic care management, Medicare annual wellness visits and advance care planning.

End-of-Life Care: Infographic

June 3rd, 2015 by Melanie Matthews

Only 27% of Americans report having talked with their families about end-of-life care, according to a new infographic by Vitas Healthcare.

The infographic examines the need for a living will and a medical power of attorney and the communication needs about these documents.

Case Management for Advanced Illness: Best Practices in End-of-Life CarePoor prognoses, the loss of functional capabilities, and the need for advanced care planning are just some of the emotionally charged challenges of caring for individuals with advanced illness.

Case Management for Advanced Illness: Best Practices in End-of-Life Care examines Aetna’s Compassionate Care program, a case management approach for this population. The payor’s initiative breaks down barriers commonly encountered in this highly sensitive stage of the health continuum while positively impacting both healthcare utilization and spend.

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9 Things to Know About Palliative Care

June 12th, 2014 by Cheryl Miller

With an aging population that is living longer—an estimated 10,000 baby boomers become eligible for Medicare each day — and a shortage of specialists trained for the field, palliative care is no longer taking a back seat to more traditional healthcare. The majority of respondents to the Healthcare Intelligence Network’s first annual Palliative Care survey in February 2014 said they have a palliative care program in place, and of those that don’t, more than half said they planned to launch a program within 12 months.

Here are nine benchmarks gleaned from the 2014 Palliative Care survey:

  • Timely referrals of patients to palliative care are one of the biggest challenges to implementing a program, according to 89 percent of respondents.
  • Frailty is a key characteristic of their palliative patient/member population, say 48 percent of respondents; other traits include impaired cognitive capacity (34 percent) and disabilities (15 percent).
  • „„Candidates for palliative care are primarily identified by physician referrals (78 percent).
  • More than half (60 percent) of respondents said that case management assessments were important tools for identifying palliative care candidates.
  • While the majority of respondents (68 percent) administer palliative care on an inpatient basis, more than half (54 percent) say care is conducted on home visits and just under a third offer palliative care at extended care facilities.
  • About 88 percent of respondents with palliative care programs reported an increase in patient satisfaction levels among Medicare participants, while 89 percent saw more satisfaction among caregivers.
  • Overall, the presence of palliative care helped to curb healthcare utilization costs for 70 percent of respondents.
  • Seventy-one percent of respondents with palliative care programs in place reported an uptick in hospice election by Medicare patients.
  • Nearly 20 percent of respondents said it was too early to tell what ROI their palliative care program generated.

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Excerpted from 2014 Healthcare Benchmarks: Palliative Care

Early Palliative Care Improves Patient Care, Reduces Hospitalizations

January 15th, 2014 by Cheryl Miller

The word palliative literally means to cloak or conceal, and is used to describe care designed to alleviate the extreme pain and suffering of those with chronic or terminal illnesses.

It’s an ironic name for a subject many medical professionals would prefer be concealed. There’s a shortfall of as many as 18,000 board certified physicians focused on palliative care and hospice care in the United States. There are 5,150 hospice programs and 1,635 hospital palliative care teams in the United States, which means there’s only one specialist for every 20,000 older adults living with a severe chronic illness, according to the American Academy of Hospice and Palliative Medicine.

Certification roadblocks and lower salaries account for part of this shortage; but, it could also be chalked up to discomfort with the subject. According to a study from Massachusetts General Hospital, which surveyed over 4,000 physicians caring for cancer patients, researchers found that while the vast majority of them said they would personally enroll in a hospice program if they received a terminal cancer diagnosis, less than one-third said they would discuss hospice options with their cancer patients early in their diagnosis.

But new research, including the results to our current 10 question survey on palliative care, is showing that palliative care programs are increasing, and can improve the patient experience and help avoid costly hospitalizations. New York University College of Nursing researchers and colleagues reporting in the Journal of Palliative Medicine found that initiating a palliative care consult in the emergency department (ED) reduced hospital length-of-stay (LOS) by 3.6 days when compared to patients who received the palliative care consult after admission. The ED is a setting for triage, treatment, and determining the sick patient’s subsequent course of care, which in this case includes a dedicated palliative care unit.

“By providing early palliative care, patient needs are met earlier on, either preventing admission or reducing length of stay and treatment intensity for patients, which reduces costs to Medicare and the government,” says New York University College of Nursing researcher and Assistant Professor Abraham A. Brody, RN, PhD, GNP-BC. “Patients receiving palliative care are less likely to be readmitted as well. Early palliative care can better help patients to have their wishes met, and allow them to return to and stay at home.”

Helping people decide how they want to spend the rest of their lives, and granting their wishes might be the most important palliative care treatment of all. NPR reports on Dr. Tim Ihrig of Trinity Regional Medical Center in Fort Dodge, Iowa, who makes house calls to his patients nearing their end of life. “What are the three most important things to you,” he asks his patient, an 86 year-old wife, mother, grandmother, and great grandmother with congestive heart failure. She answers: “My girls, playing cards once a week, and counting money for the church once a month,” and he helps her to achieve that. Patients in palliative care at Trinity Regional Medical Center cost the healthcare system 70 percent less than other patients with similar diagnoses, hospital officials say.

And palliative care isn’t going away, in fact, it’s spurred a new HBO comedy series, Getting On. Taking place in an extended care facility, the short-staffed ward tries their best to tend to their patients — some of whom have Alzheimer’s disease, but most of whom are simply old &#151 while hoping they don’t lose their Medicare reimbursement. The series makes jokes about everything from displaced fecal matter to sex, attempting to make fun out of a subject that’s been cloaked, or concealed, for a long time. Whether the series is renewed remains to be seen, but at the very least it’s provided a look at the kindness a group of workers can give their patients nearing the end of their life.

Healthcare Business Week in Review: Yoga for Caregivers, Diabetes Management, Healthcare Coverage

August 2nd, 2013 by Cheryl Miller

Offering yoga and meditation classes to caregivers of seriously ill patients just prior to starting clinical meetings on palliative care issues is one detail that sets Mount Sinai Hospital’s palliative care program apart from others. Together with Denver Hospice and Optio Health Services in Colorado, and UnityPoint Health Palliative Care Program in Iowa and Illinois, these three palliative care programs received the 2013 Circle of Life Award®, along with five others that were awarded Citations of Honor from the American Hospital Association (AHA).

Other programs involve a community-wide program to embrace the growing Hispanic community, and regular outpatient and home visits to ensure proper care transitions, and help avoid unnecessary emergency room visits and readmission to the hospital. All of the programs set out to reexamine the roles palliative care plays in healthcare by creating and championing end-of-life care for patients and caregivers throughout the healthcare system.

Providers need to reexamine certain diabetes monitoring practices that solely target acute individuals, and instead take a population health management approach to improving diabetes care, according to a Phytel study published in the American Journal of Managed Care.

Researchers found that despite national attention, uncontrolled diabetes was growing, and those patients at real risk were those that waited to seek care until their condition was exacerbated to an acute phase. A broader population-based approach was required to catch at-risk patients. Researchers recommend that provider organizations take two important steps to improve their ability to help their patients better manage their diabetes, including reaching out to their entire population between office visits so patients waiting too long to get retested are motivated to have the testing done earlier.

Economists need to reexamine their data linking the employment rate with healthcare coverage. Despite economic reports showing that the recession is over, the percentage of workers with health benefits still remains low, according to a new report by the nonpartisan Employee Benefit Research Institute (EBRI).

Links between the employment rate and health insurance coverage have been documented over the years. Since most workers in the United States get their health coverage through their jobs, a rise or drop in the unemployment rate usually means a corresponding rise or drop in the uninsured rate as well, the report states.

But these facts aren’t holding up against trends that show that nearly half of the population does not have coverage.

We’d like you to examine and respond to our current e-survey on the population health management of dual eligibles. These nine million Americans eligible for both Medicare and Medicaid present unique challenges. Public and private payors are now tailoring care coordination strategies for Medicare-Medicaid beneficiaries that are both geared to their medical, social and functional needs and cost-efficient. Describe your organization’s approach to care coordination of dual eligibles by August 6, 2013 and you will receive a free summary of survey results once it is compiled.

Infographic: Hospice Demystified

June 18th, 2013 by Melanie Matthews

Sixty-two percent of hospice patients are enrolled in hospice less than 30 days, according to a new infographic by CareGiver magazine.

The infographic also highlights where hospice patients receive care, the average age of hospice patients and who pays for the care.

Hospice Demystified Infographic

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You may also be interested in this related resource: Case Management for Advanced Illness: Best Practices in End-of-Life Care.