1. National Hospice and Palliative Care Organization’s Palliative Care Resource Series Hospice-Hospital Collaborations: Making the Case to Hospital Administrators Todd Cote, MD

2. Objectives
Review the current hospital environment and types of hospice-hospital collaborations.
Discuss benefits, barriers and challenges of hospice-hospital collaborations.
Present strategies to build a case to hospital administrators.

3. Current Hospital Environment
Focused on internal and external quality improvement
Interested in value added programs (Value=Quality/Cost)
Data-driven
Government mandates from health care reform:
Readmission rates
Mortality index (observed deaths/expected deaths)
Patient satisfaction ratings

4. Types of Collaboration
Independent Contracts with Hospitals
Medicare Hospice benefit (MHB) Hospice General Inpatient Care (GIP)
Hospice liaison nurse/ hospice inpatient team

5. Types of Collaboration
Extensive contracts
Hospice program within/or part of a hospital organization or hospital system:
Inpatient hospice and/or palliative care units
Small scale comfort suites
Palliative care consultation teams
Hospice may be subsidiary company under hospital system

6. Types of Collaboration
Contracts to Support End-of-Life Services
EOL education programs
Ethics committee membership
Palliative care coordinating committee
Case management
Advance directive programs

7. Benefits of Collaboration
Hospice
Increase access to more patients
Learn about hospital care
Timely referrals

8. Benefits of Collaboration
Hospital
Improve quality of EOL care
Learn about hospice
Improve continuity of care
Improve branding and patient satisfaction

9. Barriers and Challenges
Legal, Regulatory and Financial
Conditions of Participation: acute care hospital versus hospice(level of care/benefit periods/eligibility/relatedness)
The OIG and ‘Others”
Certificate of Need
Hospice competition
Budgetary restraints
Varying payment schemes

10. Barriers and Challenges
Systemic Process
Electronic medical record
Documentation requirements, workforce after hour call, clinician credentialing
Bed management logistics
Transitioning patients out of hospital to hospice

11. Barriers and Challenges
Institutional Culture
Quality of end-of-life care in hospitals is slow to improve
Denial of death
Lack of education

12. Making a Case to Hospital Administrators
True Partnerships
Respect and understanding from each organization and their leaders
Hospice and hospital champions
Outstanding clinical leadership

13. Know Your Hospital and Hospital Administrator
When you’ve seen one hospital,
you’ve seen one hospital!
Understand overall mission and vision
Research the administrator – background, experience with hospice, etc.
Assume nothing! Fully explain hospice the MHB and the CoPs

14. Know What the Hospital Needs
Ask administrators!
Understand government mandates – hospital re-admissions, mortality index, patient satisfaction scoring
Address end-of-life care within the hospital
Gather data showing how hospices are servicing hospitals – national, Medicare data-mining and private firms.

15. Examples: Evidence Based Data
Palliative Care Services in the hospital can reduce hospital cost. (Prevent unnecessary inpatient utilization:↓ LOS, ↓ Ancillary charges).
Post-hospitalized patients referred to hospice have lower re-admission rates.
Re-hospitalization care of hospice patients is costly to the hospital.
Education and comfort care order sets improve end of life care for patients dying in a hospital.
Hospice can improve patient/family satisfaction.
--Tangeman JC, Rudra, CB, Kerr C W, Grant PC “A Hospice-Hospital Partnership: Reducing Hospitization Costs and 30-Day Readmissions among Seriously Ill Adults”, J Pall Med 2014; 17:
--Olsen M, Bartlett A, Moynihan T: “Characterizing Care of Hospice Patients in the Hospital Setting”. J Pall Med ,2011;14:
--Bailey F, Burgio K, Woodby L, Williams B, Redden D, Kovac S, Durham R, Goode P: “Improving Processes of Hospital Care During the Last Hours of Life”. ARCH INTERN MED, 2005; 165:
--Harrison J, Ford D, Wilson K: “The Impact of Hospice Programs on US Hospitals”. NURSING ECONOMICS, 2005; 23:
--Teno, J.M. et. Al. “Family perspectives on end –of-life care at the last place of care”, JAMA,291(1),

16. Know What the Hospice Can Do
Limited hospice budget
Expert level workforce
Consideration for 24/7 services and on-call
Hospice competition – healthy vs unhealthy

17. Conclusion
Hospice–Hospital collaborations are important for the future of end-of-life care and can be a win-win for both organizations.
Collaboration involves proper planning, knowledge and leadership.
Financial sustainability is feasible but requires a true partnership based on mutual respect and support.