Posts Tagged ‘Hospice’

Infographic: Stopping the Revolving Door of Short-Term Readmissions

April 10th, 2017 by Melanie Matthews

Transitioning eligible patients to hospice can help hospitals avoid Medicare’s 30-day readmission penalty, according to a new infographic by VITAS.

The infographic examines how hospice can reduce readmission rates and increase patient satisfaction.

Reducing SNF Readmissions: Quality Reporting Metrics Drive ImprovementsA tri-county, skilled nursing facility (SNF) collaborative in Michigan is holding the line on hospital readmission rates for the three competitive health systems participating in the program.

Henry Ford Health System, Detroit Medical Center and St. John’s Providence, along with the state’s Quality Improvement Organization (QIO), MPRO, developed standardized quality reporting metrics for 130 SNFs in its market. The SNFs, in turn, enter the quality metrics into a data portal created by MPRO.

During Reducing SNF Readmissions: Quality Reporting Metrics Drive Improvements, a 45-minute webinar on May 11th at 1:30 p.m. Eastern, Susan Craft, director, care coordination, family caregiver program, Office of Clinical Quality & Safety at Henry Ford Health System, will share the key details behind this collaborative, the impact the program has had on her organization’s readmission rates along with the inside details on new readmission reduction target areas born from the program’s data analysis.

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Infographic: Medicare and End-of-Life Care

November 23rd, 2016 by Melanie Matthews

Although Medicare spent significantly more on care for people at the end of life who died in 2014 ($34,529 per person) than for other beneficiaries that year ($9,121 per person), the share of total Medicare spending for people at the end of life decreased from 18.6% to 13.5% between 2000 and 2014, according to a new Visualizing Health Policy infographic by the Kaiser Family Foundation.

The infographic also examines Medicare spending for end of life care by age, Medicare spending on hospice and the impact of Medicare reimbursement to discuss end of life care, which began in January 2016.

Medicare and End-of-Life Care

Care Coordination in an ACO: Population Health Management from Wellness to End-of-LifeWhen acknowledging its position as a top-ranking Medicare Shared Savings Program (MSSP), Memorial Hermann is quick to credit its own physicians—who in 2007 lobbied for a clinically integrated network that formed the foundation of the current Memorial Hermann accountable care organization (ACO). Now, eight years later, collaboration and integration continue to be the engines driving the ACO’s cost savings, reduced utilization and healthy patient engagement rates associated with Memorial Hermann ACO’s highest-risk population.

Care Coordination in an ACO: Population Health Management from Wellness to End-of-Life details Memorial Hermann’s carefully executed journey to quality and the culmination of the ACO’s community-based care management program.

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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

Physician Group ACOs Value Specialists, Nurse Practitioners

March 19th, 2014 by Jessica Fornarotto

As the number of public and private accountable care organizations nears 500, participants are fine-tuning the ACO model. In the few years since the ACO model entered healthcare’s consciousness, administration has shifted from hospital-led to physician-only leadership to PHO-helmed ACOs. In its third annual industry survey on ACOs, conducted in 2013, the Healthcare Intelligence Network captured how 138 healthcare organizations are participating in ACOs.

Drilling down to the multi-specialty physician group perspective, this survey analyzed the number of existing ACOs for this sector, which providers participate in the ACO, and more.

With their built-in cadre of healthcare providers, multi-specialty physician groups (referred to here as physician groups), which comprised about a tenth of survey respondents, would seem ideally placed to transition to accountable care organizations. Percentage-wise, this sector has the highest rate of existing ACOs (57 percent participating in ACOs versus 34 percent of overall respondents) and twice the rate of participants in the CMS Pioneer ACO program (25 percent versus 13 percent).

In other deviations from the norm, twice the number of physician group-reported ACOs favor the hybrid FFS + care coordination + shared savings payment model (75 percent of physician-group ACOs versus 37 percent of overall respondents).

More than half of ACOs in this sector are administered by independent physician associations (IPAs), and most are smaller than the hospital-sized ACOs reported in the survey, with three-quarters reporting a physician staff of less than 100. These ACOs benefit from having specialists on board in greater numbers to help with care coordination of the chronically ill (100 percent include specialists, versus 71 percent overall).

They also unanimously include nurse practitioners (versus 90 percent of overall respondents) and with 50 percent including clinical psychologists in the ACO (versus 42 percent overall), are a little further along on the path of integrating behavioral health into the accountable care initiative.

Cognizant of the full care continuum, these IPA-led ACOs are almost twice as likely as overall respondents to include skilled nursing facilities (50 percent versus 29 percent overall) and hospice (75 percent versus 42 percent overall) in their ACOs.

Excerpted from: 2013 Healthcare Benchmarks: Accountable Care Organizations

3 Key Post-Acute Partnerships that Reduce Readmissions

January 22nd, 2014 by Cheryl Miller


Developing post-acute partnerships with home health organizations is one of the three top ways healthcare professionals are seeking to reduce readmissions, according to more than half of the respondents to the Healthcare Intelligence Network’s fourth comprehensive Reducing Hospital Readmissions Benchmark Survey.

Almost three-fourths (67 percent) cited skilled nursing facilities (SNFs) as their preferred post-acute partner, and 50 percent said they were partnering with hospices to reduce readmissions.

Other partnerships cited included telemedicine, free/low cost clinics, physician networks, and transitional care programs.

Among other key facts:

  • Nearly all of the respondents said that partnering with post acute providers helped them to streamline processes, educate their staff, and implement effective changes of value to the patient.
  • Among respondents from hospital systems (42 percent) that partnered with home health organizations, identifying high risk individuals most likely to be readmitted post-discharge and communicating this information to providers was key to successfully averting readmissions. Involving the patient’s designated caregivers in follow-up dialogues and transactions also improved the odds of prevention.
  • In addition to post-acute correspondence with their home health organization within 24 hours of discharge, one hospital system also practiced medication reconciliation and education and physician scheduling.
  • Follow-up appointments for patients with their home health and/or SNF provider within seven days for Medicare and Medicaid patients with no primary care doctor factored into one hospital system’s readmissions prevention plan. Assuring that medication reconciliation information was made available to their post discharge providers, particularly for high risk utilizers, was also critical to prevention.
  • A hospital system that partnered with low-cost clinics in addition to home health organizations maintained daily and weekly telephonic education meetings with patients, coordinated by its diabetes disease management nurse, diabetes educator and clinical pharmacist.

The ultimate goal in partnering with post-acute providers was to engage with patients while in their facility and continue to follow up with them upon discharge, with continued education and teach back as well as monitoring and overseeing their patients’ progress.

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.

Infographic: Slow Healthcare Spending Growth Expected to Persist through 2013

October 10th, 2013 by Jackie Lyons

Healthcare spending growth through 2013 is expected to remain slow, according to the Centers for Medicare & Medicaid Services Office of the Actuary projections. Although some of the slowdown is likely due to economic-related issues, researchers also believe structural changes in healthcare delivery are playing a role, according to a new infographic from the American Hospital Association.

This infographic also shows other factors contributing to lower spending rates as well as current versus historical average growth in national healthcare spending, Medicare and Medicaid spending and hospital care spending.

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You may also be interested in this related resource: Plunkett’s Health Care Industry Almanac 2013.

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.

Aetna’s Compassionate Care Program Incorporates Holistic, Member-Centric Case Management

June 22nd, 2012 by Cheryl Miller

When a loved one is dying, continued support and compassionate care from clinicians and case managers can be a “lifeline,” at least to one member whose spouse went through Aetna’s Compassionate Care program.

And that’s one of the main goals of the program, according to Dr. Joseph Agostini, senior medical director for Aetna Medicare, who spoke to the Healthcare Intelligence Network during its Advanced Illness Care Coordination: A Case Study on Aetna’s Compassionate Care Program, a 45-minute webinar on June 13, 2012: to provide additional support to members with advanced illness and their families/caregivers, and help them access optimal care, so they can get more of the kind of care they want, and spend less time in the ICU and hospital.

A person has advanced illness if

“…he/she has one or more conditions that progress enough that general health and functioning decline, and treatments begin to lose their impact.”

Aetna’s Compassionate Care Program is a nurse case management initiative that specifically targets patients with advanced illness, and it has had a major effect on healthcare utilization and quality outcomes, he said.

The need for such a program is crucial, Dr. Agostini said, given the increasing number of elderly people with advanced illness. Studies show that:

  • The rate and rise of older Americans is growing, and 10,000 baby boomers are aging into Medicare a day; and
  • The rate of Americans 85 years and older is growing; and
  • An estimated 30 percent of Medicare costs are incurred in the last year of life; and in the last month, 80 percent of costs are for hospitalizations; and
  • While most deaths occur in the hospital or nursing home, most Americans prefer to die at home.
  • While not a goal, Dr. Agostini stresses, the Aetna Compassionate Care program has increased hospice selection rate.

    The program relies on nurse case managers to identify members for the program, and then to act as a support system for them and the community supporting them.

    There is no specific training, instead, Aetna employs a “holistic, member-centric case management plan,” and RN case managers “should have the ability to support patients through all phases of life,” says Dr. Agostini. “Addressing patients holistically is crucial, because comorbidity is common, “ he explains. According to a JAMA study, people at the end of life value different things, including freedom from pain, and having family present, and Aetna’s goal is to honor the differences.

    Case managers can help members to understand their options, address pain and other symptoms, help plan advanced care support, and provide education and awareness of resources and online tools. Training is key, Dr. Agostini says, and includes motivational interviewing, technical training, and “lunch and learns.”

    Aetna’s involvement in compassionate care was prompted by significant gaps in care for the elderly, especially end of life care. Part of the problem is a serious shortage of specialists: data shows there is one oncologist per 141 new cancer patients versus one palliative medical doctor for every 1,200 patients with serious or life-threatening illnesses.

    And there are definite benefits to introducing palliative care options sooner. According to a study from the Dartmouth Atlas of Health Care, patients pursued less medically aggressive care but lived more than two months longer, had fewer depressive symptoms and improved mood and quality of life. The explanation could be that “earlier referral to hospice could lead to better symptom management.”

    As with any program, there are certain endemic challenges, including inadequate pain treatment, late referrals, difficulties determining prognosis, and lack of emotional support.

    But overall the program has resulted in significant results, including:

  • 82 percent reduction in acute inpatient days; and
  • 77 percent reduction in ER visits; and
  • 86 percent reduction in ICU days; and
  • Improved quality of life for Aetna members and their families.
  • This last result was perhaps most important for the member who reported on her husband’s passing in hospice while in Aetna’s program. Two days before their 49th anniversary he gave her a piece of jewelry that his daughter had helped him to purchase; it was something he’d done every year since they were married. Two days later he lost consciousness, but she expressed gratitude to the team for having been given this final memory.