Hospice Referral Trends

The COVID-19 Pandemic Shifts Referral Streams

Finding New Referral Sources

• Prior to the COVID-19 pandemic, senior housing and other long-term-care (LTC) facilities were a crucial referral source of longer stay patients for hospice providers.
• When the pandemic hit and LTC facilities were shut down to outside visitors, hospice providers could no longer advocate for their services among residents and staff causing a significant decline in referrals from LTC facilities.
• As referrals from LTC facilities dropped, hospice providers were forced to seek other sources including physician offices and hospitals.

As Facilities Re-open, the Focus Remains on Physician Practices

• As referrals from long-term-care facilities bounced back in the first half of 2021, hospice providers continue to focus significant attention and investment on building referral relationships with physician practices.
  • According to a Hospice News survey of 160 hospice leaders, 41% said physician practices are the largest opportunity for referral growth in 2021 which is up from 27% in 2020.
• While they are a more fragmented referral partner than LTC facilities, physician practices represent a more untapped source that providers successfully built relationships with during the pandemic. Adding to that, the introduction of value-based hospice models in 2021 and moving upstream make physician offices even more important to focus on.
  • According to the same Hospice News survey, new physicians accounted for 24% of referrals compared to 15% for hospitals and assisted living facilities.

Closing the Hospice Knowledge Gap

Physician Education

• End-of-life care education is often overlooked within healthcare training, making many physicians and other healthcare workers unfamiliar with the patient benefits and cost savings associated with early hospice care.
• In the NHPCO’s 2020 facts and figures report, 27.9% of all hospice stays were under 8 days, 40% we’re under 14 days and just 14.1% of all hospice stays were longer than 180 days.
  • The low number of early and mid-length hospice stays plus the overall hospice utilization rate of around 51% shows the large opportunity to educate physicians and consumers on the value of early hospice care.

The benefits of developing a physician outreach and education program

• Learning to effectively communicate the value of hospice care to physicians while understanding their perspective and needs can help providers:
  • Develop long-lasting relationships with a new referral stream
  • Increase overall hospice utilization rates in their markets
  • Increase the average length of patient stays in their market
  • Achieve savings for the overall healthcare system
  • Improve the quality of life for patients, caregivers and families

Strategies for educating physicians

• Debunk the misconceptions surrounding hospice using data
• Explain how hospice can have a large impact on controlling costs while delivering high-quality care
• Help train physicians to identify the right time in a patient’s journey to transition to palliative or hospice care
• Show your understanding of value-based hospice care and your commitment to transitioning to a value-based model
• Write concise and easy-to-understand content targeted at physicians that can be shared with them online

Consumer Education

As more tech savvy generations age and become caregivers, consumers will proactively be looking for more information on hospice care. Educating this next generation of consumers through their preferred channels will be crucial to increasing hospice utilization and education among physicians.

Strategies for educating tech savvy consumers

• Meet consumers where they are (in online communities, searching in google or at local events)
• Pay close attention to your online image and quality scores
• Learn to explain quality scores and differentiators in simple terms
• Write concise and easy to understand educational content targeted at consumers and that can be shared online
• Understand different consumer priorities and needs

The Referral Stream of the Future: Value-Based Care Partners

2021 has been a monumental year for the hospice industry’s transition to value-based care models. Halfway through 2021, the CMS Innovation Center (CMMI) has three value-based hospice tests live:

• Direct Contracting for Hospice (High Needs Populations)
• Medicare Advantage Hospice Carve-in
• Primary Care First (SIP)

As hospice providers continue to prove they can thrive in a value-based payment world, some are also developing preferred relationships with Accountable Care Organizations (ACOs) to build a consistent stream of referrals from local ACOs.

Strategies to build preferred relationships with DCE, ACOs and payers:

• Efficiency – show that you are a cost competitive provider through above average benchmarks
• Quality – show your commitment to quality through consistent, high-quality measures
• Interoperability – be ready to integrate your tech stack and workflow with other providers/payers
• Service Diversification – Move upstream to palliative care and primary care services
• Care coordination – seamlessly move patients through the continuum of end-of-life care at the right cadence
• Take on Risk – learn how to manage and share risk with payers – CMS is intent on moving risk on to providers
• Strategize – understand the motives and needs of the organizations you want a preferred relationship with and prove how you can compete on cost-efficiency.

Team up with local providers to gain scale and leverage

Local small and mid-sized providers who don’t necessarily have the scale and bargaining power to negotiate with payers are teaming up to develop powerful partnerships for the value-based future. The goals of these partnerships are to:

• One Contract – Reduce complexity for the payer or DCE by developing a single contract to partner with the group
• Negotiation – Use the bargaining power of the group to get better terms on payer and vendor contracts
• Standardization – Develop a single set of quality, operational and compliance benchmarks
• Volume – Have the patient volume to qualify for joining a Direct Contracting Entity (DCE)

Some examples of successful partnerships so far include The Wisconsin Hospice and Palliative Care Collaborative, the California Hospice Network, Care Synergy Network and the direct contracting entity Advanced Illness Partners.

The Role of Interoperability in Referral Streams

As the hospice industry moves towards value-based care and technology infiltrates other corners of healthcare, interoperability becomes a selling point to referral sources and an operational advantage when collaborating with partners.

Why is interoperability key to hospice referrals?

Easier on the referrer

Based on a 2019 Brightree study that surveyed 675 home health and hospice providers and 440 referral sources:

• 70% of provider respondents reported that the number of referral sources requesting data to be sent electronically increased over the past 2 years.
• 60% of referral respondents said they would switch to a different post-acute care provider if the provider accepted electronic referrals.
• At the time of the survey, just 4% of home health and hospice organizations were set up to accept electronic referrals from an EMR system.

Value-based care requires technological collaboration and efficiencies

• Most value-based care models require participants to share patient information through an EHR system.
• Referrals made inside of an DCE or by a Medicare Advantage insurer are increasingly becoming electronic.
• Partners in value-based care models need to easily share spending metrics and quality measures in real-time.
• Hospice providers will not be an appealing partner if their own internal systems are not integrated.

Government health organizations are pushing interoperability

The Centers for Medicare & Medicaid Services and the Office of the National Coordinator for Health Information have recently passed new rules to encourage interoperability including:

• Requiring all healthcare organizations to share patient information with other parties or the patient themselves when requested by the patient (while complying with HIPAA).
• Banning contracts that block the sharing of information, screenshots or videos by any company that has access to patient information (unless sharing would compromise security of the information).