Collaboration offers ew shared benefits
Patients and families are the real winners
Collaboration has replaced competition as the key word in hospice managers’ long-range planning book. Whether it is obtaining dual certification as a home health agency, or developing a professional liaison program or a direct referral relationship with a hospital or nursing home, more hospices are finding that working with other health care providers is vital to their survival.
What once was considered anathema to some hospice managers now makes for good business as well as quality patient care, many have found. Affiliations also offer hospice staff the opportunity to share information with other health care providers about the goals and philosophy of hospice and palliative care.
"It is incumbent upon all hospice programs to collaborate with as many other health care providers as possible to make sure patients have access to hospice care," says Cheryl Arenella, MD, medical director of the Hospice of Northern Virginia in Arlington. There are many mutual benefits to a collaborative relationship, she says.
Recently the hospice program signed an agreement with George Washington University Medical Center (GW) in Washington, DC, whereby five faculty physicians who work in geriatrics become the "associate medical director" for the hospice program’s inpatient unit by sharing responsibility for providing full-time coverage for the unit eight hours a day. They also take on-call duty every fourth weekend.
But perhaps more importantly, the physicians are integrated into the functions of hospice itself they sit on the hospice’s clinical care, utilization review, and quality assurance committees, and are considered members of the medical staff.
"For a hospice program with limited resources, we have gained the expertise of five professional colleagues, and the ability to do shared research, develop a database, and use the medical school’s extensive library system," Arenella says.
From the medical center’s perspective, the arrangement gives medical students, residents, and other health care professionals particularly those who work with elderly patients a firsthand look into the world of palliative care. "We feel that there is a natural partnership for geriatrics and hospice professionals to work together," says Elizabeth Cobbs, MD, a physician in GW’s division for aging studies and services, and one of the physicians now providing on-site service for Hospice of Northern Virginia.
"I recently worked the Thanksgiving weekend at both the hospital and the inpatient hospice unit," says Cobbs. "It really struck me that the culture of the two settings was so totally different."
Am I being optimistic enough?’
Under the new agreement, GW’s residents and medical students will rotate through the hospice program. Both Cobbs and Arenella expect the education to help the future doctors become attuned to the needs of terminally ill patients. "It is really tough to change gears when you are so used to treating the patient aggressively," says Cobbs. "There is always that lingering thought of, Am I being optimistic enough for this patient?’" she explains.
"We are nowhere near developing access to palliative care in all health care settings, but these types of collaborative relationships can only help foster its growth," echoes Arenella.
Hospice managers are learning that collaboration can take many forms. The Hospice of Hillsborough in Tampa, FL, is working with three local hospitals to actually admit patients to the hospice while they are still hospitalized. The result has meant an increase in referrals for the hospice and a better continuum of care for the patient, says Elizabeth Wright, RN, CRNH, professional relations liaison at the hospice.
The hospice Medicare/Medicaid admission developed in 1996 by Hospice of Hillsborough allows patients to be transferred to hospice care and financially to be covered by the Medicare hospice benefit for several days prior to the actual transfer home under hospice care.
Usually the hospital has been losing money for these days when the DRG for a particular diagnosis has run out. The hospice reimburses the hospital at the hospice per diem rate for these days.
The physician’s transfer orders reflect that a change has been made to palliative care, the patient has been discharged from the hospital on paper, and has been readmitted under the hospice Medicare benefit, explains Wright. "The patient is no longer covered under regular Medicare because we take over the plan of care," she says.
The guidelines for an appropriate hospice admission under this "extended DRG benefit" are the following:
• The hospital’s admitting diagnosis and hospice’s life-limiting diagnosis are related.
• Discharge plans are in the process of being formulated.
• The patient’s chart reflects a plan of, or a change to, palliative care. This can include chemotherapy, radiation, infusion therapy, or tube feedings for symptom management.
The time period for covering a patient under this extended benefit is five to seven days. During the transition, the patient remains in the same bed and under the same nursing care. "This plan is beneficial to the hospital because it makes up for the revenue they may be losing. It is also ideal for family members who are not quite ready to handle having the patient at home," says Wright.
These hospice experts agree that collaboration is a management strategy with benefits for all health care providers involved. They caution, however, that the best collaborative efforts are those that build on fruitful existing relationships. "We have found that you have to have an existing relationship with the hospital for the administrators to trust that there is something good for them in this arrangement," says Wright.
"There are no short cuts to good collaboration," says Cobbs. "You must have common interests, shared goals, and a mutual understanding of what the arrangement will entail," she explains. "You must be able to communicate and negotiate," says Cobbs.
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