There is a built in challenge for hospices that are owned by a health system. The largest challenge being that hospital based hospices are departments within a health system and are treated as such. The biggest impact being some of these hospices are under-capitalized and it affects their ability to compete in the market place. During the budgeting process in a hospital, precious capital is being competed for to fund a new MRIs, surgery suites, etc. Most times, the hospice and home care departments are at the bottom of the list.

This prevents some hospices from developing their service delivery model, exploring the development of a General Inpatient Hospice strategy, implementing a more professional referral development model and the like. The result is that these hospices have a hard time completing for community based business outside the hospital.

Here are some suggestions that seem to be common in terms of needs that hospice would benefit from in terms of development.

1. Referral Inquiry to Admission. The referral inquiry to admission process is a major prerequisite for growth and quality. Most hospices do not place enough focus in this area. Investing in a redesign process will yield a great deal. With a 2, 3, 4 or 5 percent improvement in the conversion rate, Average Daily Census would grow without an increase in the referral rate.

2. Hospice Levels of Care. The use of the 4 levels of hospice care as outlined in the hospice benefits are usually underused in most hospices. Check out your revenue sources to assess where you can. What is occurring is that when a patient requires a higher level of care, the nursing team mobilizes to address the need and appropriately deals with the patient to resolve the issue. While excellent patient care is rendered, the program is not getting “credit” for the care nor reimbursed at the allowable level, i.e. General Inpatient (GIP) or Continuous Care. Thus the program is losing revenue.

3. General Inpatient Hospice (GIP). The GIP level of care is not typically utilized to its fullest to both facilitate growth and relationship development with hospitals and Skilled Nursing Facilities. For example, I would estimate that most hospice average use of GIP is .1 or .2% of the total days of care (DOC) when compared to a national average range of between 3 to 6%. GIP as a business development tool are very limited in most hospices. There is an opportunity to develop GIP Scatter Bed Programs in hospitals to assist these hospitals reduce Mortality Length of Stay, Maximize DRG Payments, decrease inappropriate hospitalizations and generate a new source of revenue for the hospitals. By developing a GIP Scatter Bed Program in the hospital, we are creating a new tool for the hospital to use in its case management efforts. The hospice with a carefully written GIP Contract can increase its revenue levels. In Skilled Nursing Facilities, the development of GIP can be used to assist us better manage our patient population, increase referrals, strength facility relationships and grow revenue.

4. Physician Resources. As a general observation, most hospices underutilize physicians in business relationships as well as the care delivery model. A physician model structured for quality and growth could be as follows:

• A Medical Director for each program to oversee patient care and do IDT Meetings.
• A Physician and/or Nurse Practitioner (we have several NP associated with several programs) to conduct Face-to-Face meetings.
• Engage Associate Physicians for each other of the major segments we are targeting for growth. These segments would be Hospital/Physician, Skilled Nursing Facilities and Assisted-Independent Living Facilities. We would engage a physician per segment per program for 8 hours of work per month at a market drive rate (usually $200/hr.).

These are a few suggestions I would specifically recommend a hospital based hospice to explore. I hospice some of the narrative here could be of assistances as you develop your budget justifications.

The Best!