Hospice providers have increasingly adopted predictive analytic systems to identify patients in need of their services further upstream in their disease trajectory, as well as to demonstrate their value to payers and referral partners, including Medicare Advantage plans. The U.S. Centers for Medicare & Medicaid Services (CMS) will begin allowing hospices to participate in Medicare Advantage in 2021 with the value-based insurance design demonstration project.
Change is coming for hospices in 2021 as the industry starts to shift towards value-based payment models, including the Primary Care First initiative. As the implementation dates for these programs approach, hospices need to identify the value proposition and revenue potential for each of the models that will fall under the auspices of that program.
The leadership team at Acclivity Health recently wrote a peer reviewed article that was published in April issue of The American Journal of Managed Care. Here’s an excerpt of the abstract:
Palliative and hospice care services produce immense benefits for patients living with serious illness and for their families. Due to the national shift toward value-based payment models, health systems and payers share a heightened awareness of the need to incorporate palliative and hospice services into their service mix for seriously ill patient populations.
During the last decade, a tremendous amount of capital has been invested to better integrate information technology into healthcare. This includes development of technologies to promote utilization of palliative and hospice services. However, no coordinated strategy exists to link such efforts together to create a cohesive strategy that transitions from identification of patients through receipt of services.
Patient- and family-facing app aids in screening, telehealth, and more
As COVID-19 continues to spread across our nation, Acclivity Health understands the growing concerns of hospice and palliative care organizations. Providers are having to limit their patient visits due to lack of staff, PPE supplies, and risk of exposure. Hospitals are transferring their seriously ill patients to hospice earlier in their effort to keep beds open for potential COVID-19 cases. As a result, hospices are seeing their census increase during this pandemic, requiring close monitoring and screening for COVID-19 while ensuring the safety of providers and their patients. To limit the spread of infection, providers must find a way to care for patients without being at the bedside.Read more
The Centers for Medicare and Medicaid Services’ Primary Care First (PCF) model will start in 2021, including the Seriously Ill Population (SIP) model. The SIP program is designed to improve care for high-need, high-risk patients who currently receive fragmented or inadequate care. To do this, CMS will assign SIP patients to participating hospice programs, paying the providers to coordinate their care and avoid unnecessary hospitalizations.Read more
Acclivity Health’s Chief Innovation and Advocacy Officer explains why patients and families shouldn’t hesitate to seek hospice care.
As seriously ill patients near the end of life, it is often suggested that hospice care become part of their health care plan. Unfortunately, patients often enroll in these services too late to reap the full benefits. Dianne Gray, Chief Innovation and Advocacy Officer at Acclivity Health, says this is often due to a stigma that surrounds hospice care.Read more
Over half of all hospice referrals today come from hospitals that often wait too long to refer a patient into hospice care. Whether they believe a referral suggests they are abandoning the patient or they anticipate higher profits from an extended stay, too often hospitals prevent patients from receiving hospice care in time to make it meaningful.
Independent physicians and specialists often don’t have the time or experience to handle hospice care coordination efficiently. However, when physician groups align with hospice organizations in a formal community structure called a Connected Care Community, these doctors can remain on the front line of their patients’ care.Read more
Today’s doctors are trained to keep patients alive, but not always to prepare them for death. From developing a care plan to delivering the news to supporting their patients’ medical, emotional and spiritual needs, most doctors are uncomfortable starting the conversations required to develop the most appropriate end-of-life care plans.
As Baby Boomers retire and age, we have an older generation that has grown up expecting continuing gains to their longevity. But longevity doesn’t mean everyone who lives longer lives in good health. In fact, according to the National Centers for Disease Control and Prevention, about 60 percent of adult Americans have a chronic disease, and 40 percent have more than one1. Our medical community needs to ensure that the sickest and most vulnerable in this generation will receive comprehensive, high-quality, person- and family-centered care that honors their dignity and choices and is consistent with their goals and values.Read more
Less than 40 years ago, when you went to the Emergency Room at your local hospital, you had no idea what kind of doctor you’d see. Staff physicians in the hospital took shifts in the ER, so you might have an obstetrician casting your broken wrist or a psychiatrist treating your heart palpitations. Beginning in 1979, Emergency Medicine was recognized by the American Board of Specialties. Over the next decades, EM specialists became thoroughly integrated into the continuum of care, so that today, patients coming into to the ER can expect treatment and a proper diagnosis from the right physician.Read more
Eighty percent. That’s how many Americans would like to die at home. But despite the fact that 70 percent of Americans die from chronic illnesses1, giving them time to anticipate their deaths, over 50 percent still die in hospitals or nursing homes.2 Of the Medicare patients who died in 2016, only 48% received hospice services at the time of death3, even though every patient was eligible for six months of hospice care.
Prior to 1950, the majority of Americans did die at home. At that time, many chronic and advanced illnesses were untreatable, and all physicians could offer was palliative care. Over the next few decades, innovations in medicine enabled doctors to prolong life with medical and surgical interventions and for hospitals to treat patients with ventilators and IV anesthesia. As seriously ill patients lived longer, medical institutions recognized advanced illness management as an effective way to maximize their profits.Read more