Hospices Looking for Census Improvements: Add Some Innovations

Most hospices I talk with are finding census gains difficult these days.  As I’ve written before, a number of factors are conspiring at the moment to keep census somewhat depressed and referrals tough to come by.

• With a struggling economy, all providers are looking for paying patient days.  Referrals that should (or would) routinely go to hospice aren’t as readily available as upstream referral sources (hospitals, skilled facilities, etc.) don’t have the depth of other paying patient pools.  In fact, all downstream providers are seeing compressed referrals.  Simply put: When the queue of paying patients is smaller due to a fall-off of privately insured patients (due primarily to high unemployment), any paying patient including those that would be or should be hospice referred is better than a vacant bed.  There simply are not enough patients with good payment sources for all of the supply of providers today.
• Hospice is a mature market or one that is stable and growing only very modestly.  Despite the fact that it is cost-effective, arguably more appropriate and better for a terminal or near-terminal patient, it hasn’t permeated the traditional patient, familial and medical community psyche to a sufficient depth to create additional demand.  Culturally, the medical community and patients still prefer to pursue curative options at virtually every step of the way as opposed to accepting death as a natural course of occurence. 
• The financial incentives favor the pursuit of more expensive care as opposed to hospice.  Payment in our system is highest and most fluid for acute, episodic, technologically based care and treatment.  A simple economic axiom applies: What gets rewarded gets done (or, follow the money).

Taking the above into account, one would tend to think that generating additional referrals is an improbable task.  While I won’t propose that doing so is easy, there are some options in terms of “innovation” that make sense.  By innovation I mean programmatic changes or new programs that tap non-traditional markets or fractional markets.  Being honest, simply marketing more or trying desperately to educate a few more patients and/or a few more physicians about the benefits of hospice care won’t create many additional referrals (again, see the top bullets for “why”). 

Here are some favorites that I have seen tested in other settings, some within hospice programs, and/or other countries.  Each is innovative and worthy of exploration by a hospice organization that is looking to create some novel niches, incremental referrals and brand differentiation.

1. Day Hospice: A variation on adult-day care, this program provides a respite style of program but for caregivers to take a few hour break.  Transportation, meals, socialization, etc. plus spiritual and other counseling typically round-out the services and where “cares” are involved, staff assist the patient as required.  A hospice could start such a program either via a partnership with an existing adult day care provider, SNF, Assisted Living, Hospital or on its own in a suitable location.
2. Disease Specific Programs: Develop end-of-life algorithms and care management programs for specific diseases such as ALS, MS, Parkinson’s, COPD, etc.  Enlist physician specialists to provide review and consultation in the program development phase and even in a supporting medical director capacity.  Consult with the local chapters of groups/associations that represent each disease (Parkinson’s Association, MS, etc.). The result of this approach is a three-fold win for the hospice.  First, a segregated category of potential new patients.  Second, a branding opportunity and co-marketing strategy through the physician specialists and the local disease representatives.  Third, a focused opportunity to educate patients and physicians on when, why and how to make a hospice referral – these folks become a “warm” group.
3. Embrace Alternative Therapies: Some organizations do this better than others but few do the compendium and certainly not as well as organizations in foreign countries (the Dutch are the best).  Here’s a few of the better concepts that I have run across.
   • Medicinal Marijuana: Now legal in 14 states and DC, medical marijuana is viewed as a wonder drug for symptom management, especially by cancer patients and patients with intolerable spasms (MS, Parkinson’s, etc.).  Embracing this option where legal and perhaps, even becoming a distributor creates a “cutting-edge” brand and a marketing advantage.
   • Acupuncture: For use either as a stand-alone symptom management aid or for adjunct therapy to deal with pain, nausea, spasms, headaches, etc.  Bringing on staff, a certified acupuncturist is again, a cutting-edge option and one that is marketable.
   • Mood Rooms: For inpatient programs, rooms developed with particular design elements have proven to be successful in easing patient’s symptoms and creating a more relaxed and tranquil environment.  Hospitals have started to embrace this level of design and there is no reason that hospices don’t do the same.  Everything from lighting to color to sound systems and views are designed to improve tranquility, comfort, and patient “mood”.
   • Others: Massage therapy, music therapy, hydrotherapy, meditation, etc., are all fair game and in one form of another, have legitimate bases for use in a hospice setting.
4. Increase the Technical Capabilities: Being more capable in terms of taking certain types of complex patients is always a cost-benefit issue although, done correctly, the return is still positive “financially”.  Patients that often don’t benefit from hospice (due to cost issues)  include ventilator patients, patients that require palliative radiation or palliative chemo-therapy, and patients that require specialty DME.  In reality, the scope of each under a terminal diagnosis is limited and with solid advanced planning. good partnerships with other providers, and effective cost management, it is possible to tackle these patients and still achieve a modest margin.  Don’t be automatically afraid or unwilling to accept patients in unusual circumstances and actually, increase your technical competence in dealing with these patients.  They are an untapped market in many regards.
5. Private Duty: For a hospice that is part of a home-care organization and/or can partner with such an entity, private duty hospice can be very profitable and very successful, albeit on a limited scale and honestly, only in certain market areas.  There remains a class of people that are terminally ill, hospice eligible and in-need (and desirous) of extended caregiver or private-duty support at home.  Targeting this market is as easy as developing good relationships with trust company officers, estate planning attorneys, and other trusted counselors to the “well-off”.  One word of caution persists, however.  This group is picky so to sustain the business, a hospice must be very customer service focused.
6. Be Palliative, Not Just Hospice: For those hospices affiliated with home care agencies or, can build a relationship with a non-competing agency, offering expertise to patients that require symptom management and palliative services only makes sense, even if the same patients aren’t yet hospice appropriate or won’t at this point, consciously elect a hospice benefit.  Expertise in symptom management and the palliation of chronic diseases is the strength (or should be) of all hospices and leveraging this strength to “marginal” hospice patients builds a bridge for the hopefully, inevitable referral.  If nothing else, this business is incremental revenue.

As I indicated, the above is just a sample of my favorites from sources where successes have occurred.  I encourage readers to add others, different ideas or to elaborate on perhaps, a twist or two to the above.  Feel free to post your comments and experiences so that I (and you) can share our “collective” knowledge.