NHPCO conference highlights opportunities for the future
This issue of Hospital Management Advisor includes coverage of key events and insights from the 18th annual conference of the Alexandria, VA-based National Hospice and Palliative Care Organization, held Sept. 7-9 in Phoenix. Our coverage includes expert opinions on what may lie in the hospice industry’s future, a look at the call for quality assurance initiatives, and insight into how one book is leading to changes at many hospices.
National Hospice and Palliative Care Organization (NHPCO) president J. Donald Schumacher, in office just one year, portrays the U.S. hospice industry and its trade organization as on the move, with opportunities on the horizon.
Schumacher’s remarks were made during his opening address at the Alexandria, VA-based NHPCO’s 18th Management and Leadership Conference, "Hospice & Palliative Care: Expanding Our Future," held Sept. 7-9 in Phoenix.
In his upbeat plenary presentation and a subsequent interview with Hospice Management Advisor, Schumacher described a number of initiatives being planned for NHPCO, while challenging NHPCO members to keep pace with the national organization’s momentum by expanding access for patients in need of end-of-life care and by paying attention to the quality and consistency of hospice care. He also pointed to recent growth in the organization’s membership and its tally of 885,000 terminally ill patients served by U.S. hospices in 2002, up 14% from 775,000 patients served in 2001.
For the first time since 1999, hospice length of service also went up, albeit slightly. According to adjusted data from NHPCO’s National Data Set, the national average length of stay in hospice in 2002 was 51 days, up from 48 in 2001. The median rose from 20.5 to 20.9 days in the same period — a step in the right direction, but still too short to provide optimal care to many hospice patients. Schumacher said he believes hospice length of stay is continuing to rise, thanks to more aggressive outreach and open admission policies by many hospices and the efforts of palliative care programs to encourage more timely referrals to hospice.
Palliative care goes mainstream
Numerous presentations and conversations among the 1,275 registered attendees at the NHPCO conference confirmed that non-hospice palliative care programs are becoming a mainstream strategic direction for America’s hospice industry. However, there remains a distinct lack of consensus about what palliative care is, how it differs from conventional hospice care, why palliative approaches are needed to supplement hospice care, and who should be providing these services.
"Palliative care essentially is hospice with a longer tail, covering a longer time frame," Schumacher told Hospice Management Advisor. The majority of American hospices still only provide hospice care, which is a form of palliative care but not the only one, he explained. From the point of diagnosis of a serious, life-threatening condition, patients often need a palliative care consultation "to help them get their feet on the road, if you will, toward the hospice door."
Such consultations could be provided by hospice team members, inpatient team members, nursing homes, or home health agencies. "But they are all, essentially, creating a pathway to end-of-life care. If the patients do, in fact, recover, then great. They go on their way," he said. But many palliative care patients eventually will qualify for hospice — and will have a better understanding of the hospice approach when its time comes.
However, Schumacher also issued a sharp rebuke to those who wish to marginalize hospice’s role in end-of-life care or offer palliative care as a substitute for hospice. "We are focused on expanding hospice and end-of-life care. We’re no longer content to sit in the back row while other providers eat our lunch leaving hospice in the dust," he said. "The feelings I’ve had for years about hospice being relegated to the back of the bus are shared by a lot of our members," Schumacher said. He added that members have told him they want to see NHPCO reclaim the initiative for hospice as the leader in end-of-life care.
"We want to integrate palliative care and palliative support into the hospice industry," he said. Alluding to America’s air traffic controllers, who made a difficult decision to shut down the nation’s airspace on the morning of Sept. 11, 2001, Schumacher said that if palliative care models are not provided in collaboration with existing hospice providers, "we’ll shut down palliative care’s airspace."
Varieties of palliative care
Various forms of palliative care were highlighted at the Phoenix conference, including partnerships between hospices and hospitals, described during a Center to Advance Palliative Care (CAPC)-sponsored pre-conference seminar, and a number of end-of-life demonstration projects funded by Promoting Excellence in End-of-Life Care of Missoula, MT.
Other sessions described a palliative home care insurance product developed by Community Hospice in Albany, NY, in collaboration with an HMO and three home health agencies; direct-to-consumer marketing of palliative care by Hospice of the Florida Suncoast in Largo; and programs targeting cardiology, pediatrics, and veterans.
In Buffalo, NY, Support Blue is the name for a palliative care consultation benefit developed by the local Blue Cross health plan and the Center for Hospice and Palliative Care. The insurer pays for up to six palliative care consultation visits for commercially covered patients. The program already has been shown to reduce utilization of emergency room, intensive care, and overall hospital services.
Another profiled palliative care consultation service, offered by Palliative Care Center of the North Shore, Evanston, IL, made 5,380 billable consultations in 2002, 83% of them in 13 area hospitals and the rest in patients’ homes, using a team comprising physicians, nurses, nurse practitioners, social workers, and a hospital liaison, as well as administrative support staff.
Hospice of the Bluegrass in Lexington, KY, is continuing to expand its palliative care consultation service, which is jointly staffed with three Lexington hospitals. Eliminating the service’s operating deficit on physician billing income has proven elusive, however, reported Susan Swinford of Hospice of the Bluegrass. Swinford said the hospice hopes to finally reach a break-even point for palliative care based on increased volume of visits at more sites.
Palliative care "is something we have to do. Ultimately, it’s important to our success, and important to the patient and family," noted William Finn, CEO of the Buffalo hospice. But he cautioned conference attendees to think carefully about how palliative care services fit with the other services they provide.
Palliative care is a positive and growing part of the health care system, added Amber Jones, consultant with CAPC. "If hospice doesn’t rise to the opportunity to provide [palliative care], somebody else will. Why would we not do that?" she told HMA. Hospices will need to learn new ways of linking with other providers such as hospitals, and this kind of collaboration may be more challenging than many realize. "In my recent experience, hospice doesn’t go with the patient often enough," Jones said. Instead, hospice needs to find reasons to say "yes" to patients instead of "no," even if that means providing simultaneous palliative and curative care — which is not what many hospice professionals expected to be doing when they came into the field.
This issue of Hospital Management Advisor includes coverage of key events and insights from the 18th annual conference of the Alexandria, VA-based National Hospice and Palliative Care Organization, held Sept. 7-9 in Phoenix.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content