I had the privilege of hosting the NHPCO conference in my hometown of Little Rock, Arkansas, and it was a fantastic opportunity to showcase the wonders of the Natural State. Throughout the event, I had the pleasure of meeting remarkable individuals and gaining insights into their accomplishments and concerns. As the conference unfolded, several recurring themes emerged among hospice providers.
One significant concern that resonated among attendees was the post-COVID landscape. While we have made strides in managing the pandemic, many hospices find that fear and anxiety still loom large. Hospice providers are now in a phase of refocusing and reassessing their programs in light of the pandemic’s impact. These discussions have brought to the forefront traditional themes related to Value-Based Insurance Design (VBID) and the need to chart new courses for existing programs and those on the horizon. Hallway discussions and presentations during the conference highlighted challenges such as shrinking margins and declining patient censuses, and influx of private equity companies into our world, underscoring the palpable industry-wide concerns.
Another topic that generated extensive dialogue was the merger between NHPCO and National Association for Home Care and Hospice (NAHC). Some participants expressed apprehension that this merger might dilute their identities, while others viewed it as a necessary evolution to sustain the homecare industry’s vitality. The general sentiment ranged from positive to neutral, with many eagerly awaiting more specific information later in the year to form an opinion. In the context of the broader trend of mergers and acquisitions in healthcare, exemplified by the recent Optum and Amedisys merger, it appears that such consolidation could indeed be the future, strengthening these two organizations significantly as they have complementary aptitudes and programs.
Staffing challenges have remained a persistent issue over the past few years, defying expectations that the problem would dissipate after the official end of the public health emergency. Many hospice programs, including my own, continue to grapple with difficulties related to recruiting and retaining dedicated staff. High turnover rates persist, and there is a growing sense that we have a brain drain of highly qualified staff to be mentors for those new entrants into our field. For many years, I used to tell my new doctors that we hire to listen to the nurses because they have a plethora of knowledge. That statement is no longer in my lexicon for onboarding inexperienced hospice physicians.
Audits and regulatory scrutiny have been recurring topics of discussion at these conferences. From Targeted Probe and Educate (TPE) audits to the newly introduced Enhanced Oversight measures, hospices find themselves navigating a complex regulatory landscape. While hospices generally support efforts to identify and address fraudulent practices, there is often frustration over audits perceived as unjustified, placing undue burden and financial strain on providers. In a world where data reigns supreme, it is bewildering to many that regulatory agencies like the OIG and CMS cannot more effectively identify unscrupulous hospice practices. Many hospice physicians and compliance staff, including myself, have devoted significant time to responding to audits and participating in Administrative Law Judge (ALJ) hearings, often achieving favorable outcomes. Nevertheless, these victories can feel pyrrhic, eroding trust in the regulatory process.
On a brighter note, technology emerged as a potential panacea for many of the challenges discussed earlier. There was a growing recognition of how technology can combat burnout, with voice-to-text tools aiding frontline staff and AI-driven solutions optimizing visit planning and scheduling. Additionally, technology could streamline the certification of terminal illness process, simplifying access to all necessary components for physicians with a simple touch. While hospice has historically prioritized a high-touch approach over high-tech solutions, there is a growing consensus that technology can enhance both the human touch and the use of advanced tools. From staffing to compliance, technology holds the potential to revolutionize our industry.
Palliative Care (PC) was on display and took central to strategies for hospices to move further upstream in the care continuum and actively pursuing value-based contracts to facilitate their expansion. Hospices are increasingly starting home-based primary care practices, particularly in conjunction with initiatives like REACH ACO and other value-based options. Hospices are diversifying into these areas to ensure that their resources are not solely concentrated within the hospice realm. Additionally, innovative models like the forthcoming GUIDE program for dementia patients, introduced by CMMI for next year, presented a promising opportunity for underfunded PC teams to attain fiscal sustainability. It’s truly invigorating to witness these programs embracing the future and actively exploring diverse avenues for success.
Recently, I encountered the term “Hobson’s Choice,” which refers to a situation where it appears there are multiple options, but in reality, only one choice is viable. It derives from a man by the name of Thomas Hobson who owned a livery stable in Cambridge, England who gave his customers the option to take the horse that is nearest the barn door or nothing at all. We must not believe we are faced with the Hobson’s Choice of the status quo, but that we have a multitude of opportunities before us that will ensure the legacy and future of the hospice industry.
