Hospice-Hospital Palliative Care Resources - Center to Advance Palliative Care
A logical way to begin discussions about creating a palliative care program is bringing hospice and hospital programs together. Collaborative pursuit of improved palliative and end-of-life care can be a win/win/win proposition for:
- Patients with serious illnesses
- Their families
- Hospices and
The following help define how hospices and hospitals can partner to achieve palliative care objectives:
Effective hospice-hospital partnerships:
- Expedite and expand access to a continuum of high quality palliative care services
The development of shared palliative care initiatives for hospices and hospitals can be facilitated. This benefits physicians, other clinical staff, and managers in both entities. There are many ways to define this relationship; the characteristics of both partners and the needs of the community served shape the specific agreement(s). The goal is to create an integrated program. It should reflect a full spectrum of services for patients and their families from the time of diagnosis throughout the course of the illness.
- Extend the hospice-hospital partnership through an improved understanding about the resources and constraints of each partner
The palliative care partnership can be an important bridge between the hospital and its hospice(s). However, each organization will need more in-depth information about its partner. For example, hospital-based providers may have a narrow view of the scope and/or location of hospice service delivery. Hospice staff may have incomplete information about relevant hospital programs and services. Accurate, current information broadens the definition of the continuum of care and enhances the ability of both providers to tailor care plans to meet patient and family needs and preferences.
- Hospice contributions to the partnership include expertise in: interdisciplinary team care management, facilitating advance care planning, end of life care clinical services, bereavement support and volunteer training and integration.
- Hospital contributions to the partnership include: acute care expertise across multiple specialties, management and marketing capabilities, and library and information system resources.
Both partners bring strengths to the development and implementation of the palliative care program. Each, however, must exercise due diligence to define and review differences in institutional culture, financing, legal, and regulatory issues. These issues may enhance or impede programmatic success.
- Identify strategies for improving patient and family satisfaction ratings
Hospice providers have consistently achieved very high consumer satisfaction ratings despite the reality that most of their patients die. Hospitals may benefit by identifying and tailoring successful hospice approaches that best meet the needs of a more broadly defined palliative care population.
Evidence from across the country indicates that quality indicators and patient/family satisfaction improve when palliative care services are available in the hospital setting. Evidence also shows that hospice referrals rise when palliative care services are available in the hospital setting.
- Provide greater access to professional community-based bereavement services for families of deceased patients
Many hospitals recognize the need for organized bereavement services. Hospices routinely offer family members and loved ones bereavement services for up to one year following the death of the patient. These services are available to the community at large and are not limited to patients who have received hospice care. By working together, hospitals and hospices can make sure that survivors get the support they need to address issues of grief and loss.
- Enhance access to appropriate reimbursement for palliative care and hospice patients
Although there is no palliative care billing code per se, established mechanisms allow professional service billing for related services: inpatient, outpatient, and in residential settings including nursing facilities and private homes. Determining how to financially support developing palliative care initiatives is a matter of significant interest for both hospices and hospitals.
The reimbursement structures for hospices and hospitals are different. As a result, opportunities to realize the financial benefits of the partnership are sometimes not recognized. For example, a hospitalized patient may elect the hospice benefit and continue to receive his/her care in the hospital setting. To enable reimbursement for these services, Medicare regulations dictate that the hospital and the hospice have a signed contract detailing the responsibilities of each party and the circumstances under which payment will be rendered.
In 2006, CAPC and NHPCO conducted a survey to re-assess the extent to which the hospice community is providing palliative care services to patients outside the Medicare Hospice Benefit. The data-collection was conducted to update the findings of a similar study in 2002.
Survey findings demonstrate that the percentage of respondents offering palliative care services to non-hospice patients has risen dramatically – from 26.2% in 2002 to 55.1% in 2006. The primary settings for these services are in the home (64.8%) and in a hospital (52.3%).
The Survey results are one chapter in a publication entitled: Navigating Palliative Care: Positioning Hospice for the 21st Century. This resource also includes a series of ten case studies documenting different program design models and a collection of tools and references to assist hospice providers who seek to establish and/or extend palliative care services. To order a copy of this publication, contact the NHPCO Marketplace at www.nhpco.com and go to Marketplace.
Alternative Organizational Structures
The structures of hospice-hospital partnerships vary.
Design considerations include:
- Locus of program leadership
- Availability of institutional resources
- Existence of competitive local palliative care and hospice programs and
- The past history of hospice-hospital shared programs.
A palliative care goal is providing services from the time of diagnosis. Therefore, a key consideration in selecting an organizational design is its potential for creating a continuum of services across institutional/provider settings.
Structural alternatives include:
- A fully integrated palliative care program with shared hospice-hospital resources addressing inpatient, outpatient, home-based care and nursing facility-based clinical services and education
- A hospice-based palliative care program affiliated with one or more hospitals and/or other community-based providers
- A hospital-based palliative care program affiliated with one or more hospices and/or other community-based providers
Designs for dedicated inpatient units also vary:
- An integrated palliative care/hospice unit
- A dedicated palliative care unit, which accepts hospice patients
- A dedicated hospice unit, which accepts palliative care patients
See CAPC publication Hospice-Hospital Partnerships in Palliative Care for information on successful models. This NHPCO-CAPC report describes nine different case studies of successful hospice-hospital partnerships in a range of healthcare settings, communities and regions of the country. The monograph also contains chapters on the regulatory and legal implications of hospice-hospital partnerships as well as tested methods for delivering palliative care in addition to the services covered by the Medicare Hospice Benefit.