Hospice-Hospital Partnerships
Overview
Rationale
Alternative Organizational Structures
Successful Models
Bringing hospitals and hospice programs together is a logical way to begin discussions about creating a palliative care program. Collaborative pursuit of improved palliative and end-of-life care can be a win/win/win proposition - for patients with serious illnesses and their families, for hospitals and for hospices. This section of the CAPC web site will help you define how hospitals and hospices can partner to achieve palliative care objectives.
Effective hospital-hospice partnerships will:
1. expedite and expand access to a continuum of high quality palliative care services
With the benefit of physicians, other clinical staff, and managers in both entities, the development of shared palliative care initiatives can be facilitated. There are many ways to define this relationship; the characteristics of both partners and the needs of the community served will shape the specific agreement(s). The goal is to create an integrated program reflecting a full spectrum of services for patients and their families from the time of diagnosis throughout the course of the illness.
2. extend the hospital - hospice 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 and/or hospices staff may have incomplete information about relevant hospital programs and services. Accurate current information will broaden the definition of the continuum of care and enhance the ability of both providers to tailor care plans to meet patient and family needs and preferences.
Hospital contributions to the partnership include: acute care expertise across multiple specialties, management and marketing capabilities, and library and information system resources.
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.
While both partners bring strengths to the development and implementation of the palliative care program; each must exercise due diligence to define and review differences in institutional culture, financing, legal, and regulatory issues which may in turn enhance or impede programmatic success.
3. 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.
4. provide greater access to professional community-based bereavement services for families of deceased patients
Many hospitals are recognizing 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 kind of support they need to address issues of grief and loss.
5. 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 in in-patient, out-patient, 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 hospitals and hospices.
The reimbursement structures for hospitals and hospices 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.
Alternative Organizational Structures
The structures of hospital-hospice 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 hospital-hospice shared programs.
Given the palliative care goal of providing services from the time of diagnosis, 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 hospital-hospice resources addressing in-patient, out-patient, home-based care and nursing facility-based clinical services and education
- A hospital-based palliative care program affiliated with one or more hospices and/or other community-based providers
- A hospice-based palliative care program affiliated with one or more hospitals 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 Hospital-Hospice Partnerships in Palliative Care .
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 hospital-hospice partnerships as well as tested methods for delivering palliative care in addition to the services covered by the Medicare Hospice Benefit.