1. Hospice Ethics “Playing by the Rules” Presenter: Diedra Kearney
Utah Hospice & Palliative Care Association
Ethics Committee Chair

2. THOSE SEEKING TO IMPROVE THE QUALITY OF LIFE FOR PEOPLE NEARING THE END OF LIFE MUST ASSUME THE RESPONSIBILITY OF GREAT TRUST. THIS RESPONSIBILITY GOES BEYOND LEGAL OR BUSINESS OBLIGATIONS. IT IS A CRUCIAL RELATIONSHIP THAT MUST BE WELL TENDED AND NOURISHED. IN FACT, THE PATIENT AND FAMILY ARE, AND MUST BE, THE CENTER AROUND WHICH EVERY CONVERSATION, DECISION, AND ACTION OF THE ORGANIZATION REVOLVES.

3. Objectives
This workshop will review NHPCO’s recently published position statement, “Hospice and Palliative Care: Ethical Marketing Practices,” and “Hospice Code of Ethics” and discuss successful implementation of the recommendations therein.
Identify internal risk areas for unethical practices, and solutions to avoid common violations.
Learn to effectively utilize your Ethics Committee and Compliance Program teams to audit and ensure ongoing best practices.

4. National Hospice & Palliative Care Organization HOSPICE AND PALLIATIVE CARE: ETHICAL MARKETING PRACTICES
The National Hospice and Palliative Care Organization (NHPCO) recognizes the importance of marketing and developing business opportunities for hospice and palliative care services in communities across the nation. (NHPCO, Ethical Principles, 2006)
Ongoing promotion of palliative and end-of-life care services through public education as well as through marketing and business development efforts are essential components necessary to assure access to all eligible individuals who want these services.

5. Ethical hospice and palliative care providers are sensitive to and exemplify the foundational hospice values of service, respect, excellence, collaboration and stewardship.
These values can both inspire and challenge providers as they promote services in the community.
They can motivate hospice and palliative care organizations to achieve common goals and be known as reliable and trustworthy healthcare providers.
They also establish accountability for sound ethical practice as providers enter the marketplace to provide access to hospice and palliative care.

6. NHPCO Position Statement
Access to Care
Competition
Customer Service Excellence & Boundaries
Hospice & Palliative Care Organizations as Referral Sources
New trends in Marketing and Communication
Traditional Media Marketing
-for more info…List location or contact for specification (or other related documents)

7. Access to Care
“Universal availability” of comprehensive hospice and palliative care services, with specific emphasis on reaching traditionally underserved populations”
Hospice and palliative care providers seek to remove barriers to people receiving quality palliative and end-of-life care. The foundation of such efforts is broad education. Grounding marketing efforts in education and building relationships with other providers are critical to making hospice and palliative care services available to those who need them.
Since Congress enacted the Medicare Hospice Benefit in 1982, education initiatives have had a positive impact—more residents of the United States have access to meaningful palliative and end-of-life services. That progress is notable and should continue.

8. Competition
Competition among hospice and palliative care providers should be viewed by providers in a positive framework and can be a healthy incentive to provide the highest quality service and increase access to care. As organizations develop new services and improve outcomes for effective and efficient patient/family care, they make valuable contributions to the industry as a whole.

9. “Not only are we held accountable for our own actions, but we are also judged by the conduct of our peers — those who operate in the same field. As such, it is essential that all hospice and palliative care organizations operate in a caring, ethical, and trustworthy manner in all facets of their clinical and business activities, seeking to uphold the highest levels of conduct. A strong organizational ethic helps to facilitate conversations between professional groups both within and outside of a hospice and palliative care organization.” NHPCO “Ethical Principles Publication” 2006

10. Customer Service Excellence and Boundaries
Many hospice and palliative care organizations have worked diligently to implement qualitative measures that facilitate establishment of standard practices that, in turn, ensure excellent patient and family care.
Excellent customer service must be provided within the parameters that constitute clinically appropriate hospice and palliative care services which are compliant with all applicable federal and state regulations. Hospice and palliative care organizations, therefore, “assume responsibility for ethical decision-making and behavior related to the provision of hospice care.”

11. Hospice & Palliative Care Organizations as Referral Sources
In addition to marketing one’s own services to the community, hospice and palliative care providers are the focus and recipients of marketing efforts by other service providers.
Because pharmaceutical, durable medical equipment (DME), funeral and cremation, homecare and many other organizations approach hospice and palliative care professionals for business, it is essential to identify prevailing federal and state legal and regulatory requirements and educate all staff
regarding them.
It is also important for staff to be educated on the ethical norms of marketing and business development.

12. New Trends in Marketing and Communication
“Ethical guidelines in social media are crucial for keeping us safe while keeping the Internet open for both communication and commerce…. Honesty, transparency, respect, privacy, relevance and responsibility” are foundational elements for these guidelines. (Ethics Blog, retrieved February 9, 2010)
As hospice and palliative care organizations use podcasts, blogs, and social networks (e.g., Twitter, Facebook, MySpace, LinkedIn, YouTube), they must do so responsibly.
procedures as set forth in the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy and Security Rules. (U.S. Department of Health and Human Services, Health Information Privacy, 1996)

13. Traditional Media Marketing
The use of print and broadcast media, such as newspaper advertisements, billboards and radio, have also been valuable and effective ways of communicating with the public about hospice and
palliative care services. They help educate and inform the community at large and can lead to greater access to palliative and end-of-life services.

14. Statement of Ethics American Marketing Association
“As marketers, we recognize that we not only serve our organizations but also act as stewards of society in creating, facilitating and executing the transactions that are part of the greater economy. In this role, marketers are expected to embrace the highest professional ethical norms and the ethical values implied by our responsibility toward multiple stakeholders (e.g., customers, employees, investors, peers, channel members, regulators and the host community).” 

15. The NHPCO Ethical Marketing Statement includes:
“…if competitive practices strive only to gain an advantage based on promises that go unfulfilled or overextension of services that in essence become inducements for referrals, this leads to inferior quality and reflects poorly on the hospice and palliative care industry.”

16. What to Do Clarify, communicate and reinforce your values Don't assume
Eliminate all bonuses tied to admissions  

17. Clarify, communicate and reinforce your values
The leadership team must embrace and act within the context of the values. If openness and honesty are values, then staff need to see the leadership team communicating in an honest manner
Link values adherence to performance reviews
Recognize employees and teams/departments that exemplify the organizational values
Weave values into educational offerings, providing examples of how a topic can be addressed in the context of the value
Ensure that department goals – especially the marketing department’s goals – are written within a framework of your values.

18. Don't assume
As leaders it’s our responsibility to know what our staff are saying when they represent the organization.
Periodically accompany marketing and intake staff on visits to hear how they present the organization to referral sources, patients and families.
Mystery shop – call or have someone you know call your organization pretending to be a family member seeking information about the care and services you offer
Ask questions on your family satisfaction survey about the intake process and on the referral satisfaction survey about the marketing team

19. Eliminate all bonuses tied to admissions
Monetary rewards for intake or marketing staff cannot be tied to admissions or length of stay.

20. Conclusion
NHPCO’s stated position provides guidance on ethical practices as providers market end-of-life care services and respond to the marketing efforts of other providers. It is also intended to be a catalyst for dialogue within and among organizations that provide hospice and palliative care—a dialogue that will support ethical standards of practice for those who market hospice and palliative care services.
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