Five Ways Hospices Can Grow Census and Improve Margins in 2021

Hospices on calendar-year budgets are hard at work on their 2021 numbers. Many are hoping to catch up after dealing with unexpected costs associated with COVID-19 such as PPE and technology. There are two ways to increase net revenue: volume and margin. For a hospice, that means growing daily patient census while reducing per patient costs. Here a few ideas to implement in 2021:

1. Examine Prescribing Patterns

Drug costs typically make up seven to eight percent of a hospice’s expenses. Even if your numbers look good, there may be room for improvement. Deprescribing is one way to reduce costs that can also improve quality of life for your patients. The benefits of “maintenance medications” that slow the progress of a disease become less relevant for hospice patients. Meanwhile, the side effects can negatively impact quality of life. Choosing lower cost alternatives can maintain or even improve clinical outcomes. For example, a patient’s diminished lung capacity makes expensive inhalers problematic, while more cost-effective nebulizer treatments improve absorption. Educating both clinicians and patients on these issues is essential, but it pays dividends.

2. Reach Out to Payers

With the larger shift to value-based care, managed care organizations will play a more active role in hospice. Several Medicare Advantage (MA) plans are participating in the “hospice carve-in” demonstration next year. There are also a number of initiatives aimed at increasing utilization of palliative care prior to hospice election – a growth opportunity for hospices that also offer such services. If your hospice has been invited to participate in a Medicare Advantage plan’s network for the first year of the demonstration, devote resources to getting the most out of that relationship. However, it’s also worth reaching out to all MA plans in your area. Research has shown that while Medicare Advantage participants elect hospice at higher rates than other Medicare beneficiaries, they do so later in their disease progression. Coordinating with plans, particularly care management departments, helps hospices make a greater impact on patients’ lives over a longer period.

3. Leverage Your EMR

Electronic medical record systems (EMRs) have become the primary tool for hospices to track and report on quality indicators, but they aren’t always used to their full potential. Internal analysis by Enclara Pharmacia shows significant improvements associated interfaces between hospices’ EMRs and Enclara’s systems, including 20-30 minutes saved per admission and 74 percent fewer phone calls. EMRs can also be used to apply basic principles of customer relationship management (CRM) or complement standalone CRM systems like Salesforce. Either way, CRM can help hospices better track and respond to patient and family preferences, maintain strong referral networks and improve outreach to the community.

4. Build Cultural Competency

The utilization of hospice and palliative care is lower for racial and ethnic minorities, as well as for those living in disadvantaged communities. Cultural attitudes play an often-overlooked role in this disparity. For instance, Hispanic/Latinx communities often place a high value on privacy around medical diagnoses. Such attitudes are associated with a reluctance to elect hospice in favor of keeping care within the family. In the Black community, distrust of the health system makes many skeptical of withdrawing curative treatments at the end of life. To address these issues, hospices must build strong relationships with trusted members of underserved communities and maintain a culture of inclusivity in their own organizations. It’s not something that happens overnight, but the progress you make will lead to a better future for your hospice and the communities you serve.

5. Track More Data

Tracking new data around outcomes and utilization presents opportunities to improve care and lower costs. Drilling down on your existing data may reveal trends you wouldn’t otherwise notice. Perhaps one team or location needs a refresher on deprescribing strategies or utilization of technology. Reporting on additional indicators can also uncover opportunities. Breaking out drug utilization by disease state can help identify both gaps in prescribing and overprescribing. For instance, patients with advanced dementia often remain on drugs indicated for early stages with little benefit. However, some patients with mild dementia alongside an unrelated terminal condition could experience improved quality of life with those same drugs. You could have a treasure trove of actionable data hiding right under the surface.

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