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Disease-specific programs enhance care
Focus on community to reach new patients needs
Developing a business model or marketing strategy that includes services focused on specific patient populations does not necessarily mean that a hospice is targeting higher revenue patients as implied in a study recently published in the Journal of the American Medical Association,1 but it often represents a response to a community need, says Carole Fisher, president and chief executive officer of Nathan Adelson Hospice, a not-for-profit hospice in Las Vegas, NV. One way to improve care is to improve care by addressing specific patient needs," she says.
Although hospices accept all appropriate hospice patients according to Medicare's Conditions of Participation, some hospices are developing disease-specific programs to provide more focused care for some conditions. "We developed a program to address the needs of patients with pulmonary diseases such as chronic obstructive pulmonary disease (COPD)," says Fisher. "COPD patients are an underserved population in our area and offering services that are specific to their needs was the right thing to do," she adds.
"My hospice has specific programs for Alzheimer's, congestive heart failure, and COPD," says Mark M. Murray, president and chief executive officer of The Center for Hospice Care, a not-for-profit hospice in Mishawaka, IN. These are non-cancer diagnoses for which it is more difficult to predict length of service, and which typically result in longer lengths of service, he says. "It is a good business model that results in our hospice providing service to a variety of patients who benefit from hospice care," he adds.
Murray was surprised that the JAMA article used the care of dementia patients as an indicator that for-profit hospices were selecting patients who required less expensive care. "Dementia-related deaths increased by 46% from 2000 to 2006, which means this is a population that hospices should be serving in increasing numbers," he says.
The key to providing good hospice care is to look at the needs of your community, he suggests. "This study did not look at local needs that drive the programs you develop or the patients you serve," he adds. "We developed our COPD program because a high percentage of our community members smoke and develop lung diseases," he explains.
Programs that provide care to patients in nursing homes are also important regardless of the hospice's tax status, says Joan M. Teno, MD, MS, professor of community health and medicine at the Warren Alpert School of Medicine of Brown University and associate medical director for Home and Hospice Care of Rhode Island, a not-for-profit hospice in Providence, RI. Hospices and nursing homes can work together to provide the best care possible at the end of life, she says.
"Not only can hospice staff and volunteers provide the hospice services directly to nursing home patients, but they can also serve as consultants and educators to support the nursing home staff," says Teno. "The nursing home will have patients who don't qualify for hospice care, but may need palliative care and a partnership with a hospice can benefit those patients as well," she says. In order for all areas of health care to provide the best care possible, it is necessary to look for innovative ways to partner with each other, she suggests.
While hospice was originally focused on care of cancer patients, the increase in the number of non-cancer diagnoses has changed the needs of hospice patients, says Fisher. She adds, "At one time, hospices tried to be everything to everybody but now we see patients with a wide range of diseases that increase the need to offer some disease-specific programs.
1. Wachterman MW, Marcantonio ER, Davis RB, et al. Association of hospice agency profit status with patient diagnosis, location of care, and length of stay. JAMA 2011;305:472-479.