Trading independence for influence in the system
3 hospice stalwarts talk about taking the plunge
Three hospice managers in three different long-established community-based hospice programs recently took the plunge and traded their hospices’ independence for negotiated places in larger systems. All three executives seem upbeat at least today and point to new opportunities that have come their way to influence end-of-life care in their larger systems.
"We recently had our official signing ceremony, and as of July 1, Hospice of North Iowa is now a subsidiary of North Iowa Mercy Medical Center’s integrated delivery system," says Ann MacGregor, CEO of the Mason City hospice. "Our hospice program is in 16 counties; the delivery system is in 23. It’s a rural community health system, and it’s the only system, so we didn’t have to think which one," MacGregor says.
"There were issues to be resolved, sure, but no deal breakers. We approached them after thoroughly investigating horizontal alliances and mergers. They wanted us badly; we were in a position of financial strength. What was hard was giving up autonomy, identity, and control," even though the hospice retains its own corporate identity.
"I think it was a win-win situation with a vision statement we mutually collaborated on. Time will tell if we achieved what’s in the mission statement. I have a great deal of trust and respect for our new partner." Is this partnership on the road to becoming a true integrated system? "I believe so with all of my heart. They have done it in a variety of ways, so the functional piece should follow their historical pattern of behavior. We are creating a clinical services integration team representing both sides and all settings. Now the real work begins. The rubber hits the road."
Wissahickon Hospice in Philadelphia recently merged with the University of Pennsylvania health care system, and hospice coordinator Priscilla Kissick, MN, says, "It’s great, and it’s awful. I just got a call to begin integrating end-of-life care into the medical school’s curriculum. This is something I thought would never happen in my lifetime. It’s wonderful to be part of a system that is being [accredited by the Joint Commission on Accreditation of Healthcare Organizations] as a system. It elevates everything to a more integrated level. But it’s hard on our staff. It’s a paradigm shift; it’s very traumatic for staff. It’s a wonderful challenge, but there’s too much to do."
"We realized a couple of years ago that this was the way we had to go," in a city with six medical schools and four emerging dominant health systems. "We had a strategic planning process with the goal of aligning with the best system and best fit, in terms of geography and referring physicians. Board leadership was key. Our board retained certain powers, things we hold dear to our heart," she says.
"We’ve won a lot of victories within the system. With the head of the Cancer Center on my letterhead, oncologists are more likely to say, Sure, I’d love to talk to you.’ Thanks to the politics we’ve played, we’ll now have a chance to influence the bigger system," Kissick says. "We only want to do what we do well. We don’t want to do all the palliative care throughout the system, but we can influence care beyond the Medicare hospice benefit."
Hospice of Greater New Orleans was recently acquired by Chicago-based Service Master Home Health Services. The hospice anticipates being part of an integrated home care product line, now being assembled by Service Master, which will supply the home care component for a forming system of eight local nonprofit hospitals. The hospitals are vertically integrating as part of a "a long-term survival strategy," given the presence of hospital chains Columbia/HCA and Tenet in the New Orleans market, says hospice CEO Jo-Ann Mueller, MBA.
"It’s hard being independent, out there all alone," she adds. "We now sit down with staff at the hospitals to review patients and determine the most appropriate setting for their care. We also plan to utilize our home health license for a palliative care piece, as a bridge for patients with an early diagnosis of an illness that is not likely to get cured. That way, they never have to get established with another home health agency," Mueller says.
"Our referrals have doubled. We still have a short length of stay, but not as bad as it was. [The acquisition is] going to teach a lot more people what hospice is. It also opens doors to managed care. I think it’s because of being at the table," she adds. "If anybody can get to the table without being acquired go for it. For us, sure there have been changes. Nothing is ever perfect. The real secret is knowing who you’re getting into bed with."
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