Pamela M. Barrett, ACSW, FACHE P Barrett & Associates LLC © 2012

 Bereavement  Pastoral Care/ Chaplaincy  Social Work  Complimentary Therapies

 1. Describe why holistic hospice care may be threatened in era of increasing financial and regulatory pressures.  2. Distinguish the difference between regulatory requirements, performance competency and performance standards.

 3. Identify two or more methods administrators may use in calculating the cost and performance of each discipline.  4. Synthesize the insights presented in order to critically evaluate and make changes, if indicated, to modify cost and benefits.

 Good Sense + Dollar Savings = WIN/WIN!  Demographics  Patient choice  Ethical considerations  Cost savings

Dame Cicely Saunders? Elizabeth Kubler Ross? Angelica Thieriot? Mary Tyler Moore?

 Planetree is most simply a philosophy of PATIENT CENTERED CARE. It's doing what's right for the patient and their families FIRST, LAST and ALWAYS.  “Since our founding by a patient in 1978, Planetree has defined what it means to be patient-centered.”  Planetree’s international membership is comprised of more than 500 organizations from five countries.

 Planetree philosophy: treating the whole patient—body, mind and spirit.  An organization that develops and implements guidelines for patient-centered care.

The International Alliance of Patients' Organizations (IAPO) states: “The essence of patient-centered healthcare is that the healthcare system is designed and delivered to address the healthcare needs and preferences of patients so that healthcare is appropriate and cost-effective.”

 Respect  Choice and empowerment  Patient involvement in health policy  Access and support  information © 2006 IAPO. Adopted in February 2006 by IAPO following member consultation and agreement by the Governing Board. Contact IAPO at

 Others also have patient- centered goals  Increasing expectations for accountability  Pressure from “hospice-like” alternatives  Anticipated bundled payment models  Value-based purchasing  Everything is questioned and therefore must be measured/ quantified/ valued

 Social Work  Pastoral Care  Bereavement  Alternative/Ancillary/Complimentary Therapies  Showing up was appreciated; often adequate

 Regulatory Requirements  Competency Requirements  Performance Standards  Each of the above is different and must be addressed for each discipline

 Title 42: Public Health PART 418—HOSPICE CARE  REVIEW: OIG Compliance Program, Guidance for Hospices-- Federal Registry/ Vol. 64 No. 192/Tuesday, October 5, 1999/Notices

 Competencies are identified behaviors, knowledge, skills, and abilities that directly and positively impact the success of employees and organizations.  Competencies can be objectively measured, enhanced, and improved through coaching and learning opportunities.

 Specific performance expectations for each critical job responsibility.  They explain how the job is to be done, plus the results that are expected for satisfactory job performance.  They tell the employee what a good job looks like. The purpose of performance standards is to communicate expectations.

 Documentation will include x/y/z  Clinical visit activity will be recorded within y timeframe  A fulltime employee will make x- y patient contacts per day/week/month.

The way we spend our health care dollars does NOT always make sense!! An estimated 20-30% of Medicare spending has been demonstrated to be Wasted/unnecessary/duplicative

The perceived and measurable benefits need to exceed the burden (cost) of the service  Cost per Visit  Cost per Day of Care  Cost per Patient Served

 Total* Discipline Costs/ All Visits Made = Cost per visit  Total Discipline Costs/ Total Days of Care = Cost per DOC  Total Discipline Costs/Total patients served = Cost per PS *Total= Direct and Indirect Costs

 $ (2080 x $45.00 = $93,600)  $  $  $ Would YOU pay for YOU ?

 Access to Medicaid/Services/Benefits  Decrease in Spiritual/Emotional suffering  Improved Coping for Survivors  ____________________________? What role might VOLUNTEERS play?

 Impact on Admissions/LOS/ Hospital Re-admissions  Patient and Family Satisfaction  Team Performance  Fundraising & Constituent Services

It All Depends…  Is the task needed? required? desired?  What does it cost to administer program?  What is the value (the BENEFIT) provided?  What is the value (the BENEFIT) added?

 Medicare is the primary payment source  Medicare is seeking to reduce payments  Reimbursement not keeping pace with costs CAN YOU HELP SOLVE THIS CHALLENGE?  Reduce cost  Improve performance  Be open to new delivery models

 Regulatory Requirements- Documentation REALLY Matters  Competency- It MUST be Demonstrated  Performance- Keep ONLY the Best  Not all will make it in an era of greater accountability!

Performance Behavior Grid Consider adding? Discuss with CT From Accountability Webinar ( Barrett/ Tilley 2011)

 Pastoral Care/ Bereavement  Social Work  Music Therapy

Pam Barrett P Barrett & Associates LLC (Dollars and Sense: Valuing the Counseling Disciplines; All Rights Reserved)