The last few years have been a wild ride for all sectors of the economy, but the hospice community has faced some unique challenges. After two years of pandemic restrictions limiting hospice patient referrals and access to long-term care settings, 2022 brought an uneven but significant recovery in hospice referrals. However, staffing shortages limited the ability of some hospices to meet their admissions goals, while increased compensation and recruiting costs reduced margins. The big questions for 2023 are whether these trends continue and what else might be lurking beyond the horizon.
Can Technology Help Address Hospice Staffing Challenges?
“We’re seeing some recovery around nurse staffing but the long-term trends are clear. An aging population will require more care and nurse retirements are outpacing the number of people entering the profession,” Enclara Pharmacia CEO, Mark Morse, said. “With staffing a continued challenge, Enclara intends to spend more time and resources on refining our tools and workflows to further enhance nurse productivity. Every minute we give back to a nurse through frictionless medication management is another minute available for patient care.”
In 2022, Enclara made a big down payment on that goal with the release of the new E3 ProTM, a web portal and mobile application hospices use to manage patient medications. Hospice nurses consulted on every phase of development so it’s no surprise that initial feedback has been positive. However, Enclara’s Product Development team isn’t slowing down. They have a long list of enhancements to E3 Pro planned for 2023 and other innovations in the pipeline to support hospice operations.
“In recent years, hospices have embraced technology in a big way. We’re seeing more digital adoption than ever, even from clients that were initially resistant to tools like electronic profiling and utilization dashboards,” Enclara AVP, Product Development, Megha Kadiyala, said. “The next step is predictive modeling, spanning the whole life cycle from pre-admission to post-enrollment family support. We’re going to see a number of players entering the market promising to make hospices more efficient, but only some will have the clinical and operational experience needed to truly deliver.”
How Can Education Help Hospice Patients, Caregivers and Clinicians?
As hospices become increasingly comfortable with technology at the operational level, they are also using technology to connect with patients and caregivers. Although pandemic-era waivers allowing greater telehealth utilization have expired, those tools aren’t going away. Indeed, with over half of all Baby Boomers currently using telemedicine or open to doing so, there is a growing expectation for digital tools to be available. It’s not just telehealth – growing acceptance of health tracking apps, smart devices and QR codes among seniors creates opportunities for hospices to engage with and inform their clients in ways that set them apart in the marketplace.
“Advancements in both technology and clinical best practices have the potential to improve the hospice experience for everyone,” according to Enclara SVP, Business Development, Deanna Douglass, PharmD. “One of the most promising applications is around caregiver education and Enclara is currently working on some tools to support hospices in that area.”
Education is also top of mind for Enclara VP, Clinical Management, Ryan Krout, PharmD. His team provides nurse-facing educational resources for Enclara’s hospice clients as well as materials they can share with patients. This has taken on even more importance due to the evolution of the nurse labor market in recent years. “We have seen many nurses retiring early or taking roles in other fields, over and above what had been expected prior to the pandemic,” Krout said. “Between employers improving compensation and economic headwinds, I think we’re going to see some of those nurses returning to the profession. They are going to need to brush up on skills and that’s an area where Enclara provides a unique benefit for clients.”
What is the Outlook for Palliative Care in 2023?
While staffing and technology are two areas where trends are clear, the future of hospice and palliative care payment models is hard to predict. As the “hospice carve-in” demonstration enters its third year, hard data is still hard to come by, particularly around a key benefit: concurrent care.
“The option for patients to receive both palliative and curative care for up to 30 days before hospice enrollment was a big selling point for the VBID model,” Enclara VP, Client Services, Patrick Leary said. “However, we haven’t seen a lot of results of that yet. It’s an area where we think Enclara can provide a lot of value to hospices entering that space, so I’m hoping we’ll start to see some more movement there in 2023.”
Leary has good reason to be hopeful: Several recent studies have shown a strong benefit to greater flexibility for patients with a life-limiting illness. For example, another Medicare demonstration, the Medicare Care Choices Model (MCCM), has recently released data showing a significant benefit to concurrent hospice and curative care, including improved patient satisfaction and a 14% reduction in the overall cost of care – over $7,000 per patient. Additionally, one recent study suggests that lifting Medicare’s restriction on dialysis for hospice patients with end-stage-renal disease could significantly improve their hospice utilization and quality of life. Currently, Medicare beneficiaries with both kidney failure and another life-limiting illness can only access hospice in their last days of life.
“We don’t have a crystal ball, but I can guarantee one thing,” Morse said. “No matter what the future holds for the hospice benefit and the hospice business model, Enclara will remain committed to our core mission: delivering innovative pharmacy solutions to enable providers and caregivers to improve quality of life for individuals experiencing progressive illness.”
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