CULTIVATING A PALLIATIVE CARE INITIATIVE THAT

ACCELERATES REFERRALS

DEMETRESS HARRELL

CHIEF EXECUTIVE DIRECTOR

HOSPICE IN THE PINES

SPEAKERDEMETRESS HARRELL –MA,

LBSW

SPECIAL THANKS PROCARE - HOSPICE CARE

SPEAKER’S COMMENTARY DEMETRESS CURL-HARRELL HAS BEEN EMPLOYED IN THE HOSPICE INDUSTRY WITH THESAME ORGANIZATION FOR MORE THAN 24 YEARS AND REMAINS DEDICATED TO THEADVOCACY OF QUALITY END OF LIFE CARE. DEMETRESS CURRENTLY SERVES ON THENATIONAL HOSPICE & PALLIATIVE CARE ORGANIZATION’S NCHPP-CEO STEERING COMMITTEEWHICH IS COMMITTED TO ENHANCING THE LEADERSHIP OF HOSPICE PROFESSIONALSTHROUGH COACHING, RESEARCH AND EDUCATIONAL TRAINING BOTH NATIONALLY AS WELLAS INTERNATIONALLY. DEMETRESS HAS MADE A SECURE PLEDGE TO THE EVOLUTION OFQUALITY HOSPICE CARE BY ASSURING EVERY PATIENT HAS THE RIGHT TO DIE WITH DIGNITYAND THAT FAMILIES RECEIVE THE BEST PROFESSIONAL SUPPORT THROUGH INDIVIDUALS ASYOURSELVES. CULTIVATING A COHESIVE TEAM IS SUCH A VITAL COMPONENT IN THESUCCESS OF YOUR HEALTHCARE PROGRAMS & SEEKING OBJECTIVE OPPORTUNITIES TOACCESS REFERRALS QUICKLY IS KEY.

PERSONAL DIALOGUE

WHILE DEMETRESS HAS PRESENTED ACROSS THE NATION ON TOPICS ASSOCIATED WITHHOSPICE AND PALLIATIVE CARE, NOTHING HAS BETTER PREPARED HER FOR THE ROLE AS A(ONLY CHILD) CAREGIVER FOR HER FATHER, LIKE THAT OF HER PROFESSIONAL ROLE AS AHOSPICE PROVIDER ON A DAILY BASIS.

MEMBERS OF A COHESIVE TEAM MUST EXHIBIT THE QUALITIES TO EFFECTIVELY GAIN THE BUSINESS

SESSION OVERVIEWTHIS SESSION WILL APPRAISE VALUABLE TECHNIQUES AND EXAMINE IMPACTFUL METHODS USED TO PROMOTE PALLIATIVE CARE REFERRALS IN HOSPITALS AND ACO’S. ATTENDEES WILL IDENTIFY SKILL GAPS IN PALLIATIVE CARE SERVICES AS WELL AS UNDERSTAND THE INITIATIVES DRIVING PALLIATIVE EDUCATION ON CAPITOL HILL. BY OPTIMIZING LEADERSHIP DEVELOPMENT IN PALLIATIVE CARE ASSESSMENTS YOUR TEAM WILL UNDERSTAND THE REQUIRED INTERDISCIPLINARY MEMBERS BENEFICIAL IN BUILDING A QUALITY PALLIATIVE CARE TEAM.

THIS PRESENTATION WILL ALSO DEFINE FIVE KEY PALLIATIVE CARE COMPONENTS ESSENTIAL IN RECRUITMENT AND RETENTION OF REFERRAL SOURCES. MANY HEALTHCARE PROGRAMS LACK COMPETENCY IN GATHERING APPROPRIATE MEDICAL DATA TO SUPPORT ADMISSIONS AND THEREFORE OBSERVE INCREASED DEFICIENCIES IN PERFORMANCE WHICH LIMIT CONVERSION RATES.

• PALLIATIVE CARE SERVICES HAVE SECURED AN AGGRESSIVE FOOTHOLD WITHIN THE UNITED STATESLANDSCAPE. THERE IS A GROWING INITIATIVE AMONG HEALTHCARE PROVIDERS TO SHARE THEPALLIATIVE MARKET AND HOSPICE PROFESSIONALS UNDERSTAND THE VARIOUS AVENUES TOINCREASE COLLABORATIVE EFFORTS. PALLIATIVE CARE FOR ADULT AND PEDIATRIC PATIENTSCOMBINED WITH THE PRINCIPLES OF STAFF EDUCATION WILL INCREASE CULTURAL AWARENESS ASWELL AS COGNITIVE DIMENSIONS IN SERVICES. THERE IS GROWING EMPIRICAL EVIDENCE THAT THEU. S. HEALTHCARE SYSTEM FAILS TO MEET THE NEEDS OF CHILDREN WITH LIFE-THREATENINGCONDITIONS AND THEIR FAMILIES. THE CONFLUENCE OF SEVERAL RECENT DEVELOPMENTS HASCREATED A CRITICAL WINDOW OF OPPORTUNITY FOR IMPROVING CLINICAL PRACTICE ANDINSTITUTIONAL EFFECTIVENESS IN PALLIATIVE CARE INITIATIVES. CHALLENGES WILL BE EXPLORED ANDTHIS SESSION WILL OPEN A DIRECT ROADMAP TO THE METHOD TO ACCELERATING PALLIATIVE CAREREFERRALS.

CURRENT STATE IN THE PALLIATIVE CARE

INDUSTRY:

THE WONDERFUL MILESTONE

• THE PALLIATIVE CARE AND HOSPICE EDUCATION AND TRAINING ACT PASSED THE HOUSE THIS MONDAY, JULY 23, 2018. NOW, IT IS ON TO THE SENATE! IT IS CRITICAL THAT ALL OUR ADVOCATES TAKE ACTION TO ASK THEIR SENATORS TO SCHEDULE A VOTE AND VOTE YES ON PCHETA!

• PALLIATIVE CARE AND HOSPICE EDUCATION AND TRAINING ACT (H.R. 3119).

• NHPCO IS COMMITTED TO IMPROVING END OF LIFE CARE AND EXPANDING ACCESS TO HOSPICE CARE WITH THE GOAL OF PROFOUNDLY ENHANCING QUALITY OF LIFE FOR PEOPLE DYING IN AMERICA AND THEIR LOVED ONES. PALLIATIVE CARE IS A KEY ASPECT OF ENSURING PATIENT COMFORT AND QUALITY OF LIFE.

HOORAY

IMPACTFUL CHANGE

TRAINING PROTOCOL

• THE PALLIATIVE CARE AND HOSPICE EDUCATION AND TRAINING ACT (PCHETA) WILL ALLOW THE MEDICAL COMMUNITY TO MAKE GREAT STRIDES IN THE EDUCATION AND TRAINING OF PROFESSIONALS IN PALLIATIVE CARE. PCHETA WILL FUND PROGRAMS TO PROVIDE CLINICAL PALLIATIVE MEDICINE TRAINING IN A VARIETY OF SETTINGS, INCLUDING HOSPICE, AND DEVELOP SPECIFIC MEASURES TO EVALUATE THE COMPETENCY OF TRAINEES.

RECENT OIG REPORT

• USE OF HOSPICE CARE HAS GROWN STEADILY OVER THE PAST DECADE, WITH MEDICARE PAYING $16.7 BILLION FOR THIS CARE IN 2016.

• THE REPORT FROM THE OFFICE OF INSPECTOR GENERAL (OIG) AT THE DEPARTMENT OF HEALTH AND HUMAN SERVICES SUMS UP OVER 10 YEARS OF RESEARCH INTO INADEQUATE CARE, INAPPROPRIATE BILLING AND OUTRIGHT FRAUD BY HOSPICE.

• OVER THE LAST 10 YEARS THERE HAS BEEN AN INCREASE IN NEW HOSPICE PROVIDERS BY 53%

• OIG ALSO FOUND THAT BENEFICIARIES AND THEIR FAMILIES AND CAREGIVERS DO NOT RECEIVE CRUCIAL INFORMATION TO MAKE INFORMED DECISIONS ABOUT THEIR CARE.

SOME AGENCIES ARE WORKING OVERTIME TO MAINTAIN INTEGRITY

CMS REPORTS

• MEDICARE FRAUD IS A HUGE PROBLEM. THE PROGRAM SPENDS MORE THAN $600 BILLION A YEAR ON HEALTH CARE FOR TENS OF MILLIONS OF SENIORS, WITH FRAUD AND INAPPROPRIATE BILLING REACHING AS HIGH AS $60 BILLION A YEAR. THAT AMOUNT IS ALMOST TWICE AS MUCH AS THE NATIONAL INSTITUTES OF HEALTH SPENDS ON MEDICAL RESEARCH EACH YEAR.

CULTIVATING A PALLIATIVE CARE INITIATIVE THAT ACCELERATES

REFERRALS

TRAINING VS. DEVELOPMENT• EMPOWERING PROFESSIONAL DEVELOPMENT

• KNOW YOU MARKET

• BUILD RELATIONSHIPS THAT LAST

THE COLLECTIVE MOTIVATION OF YOUR TEAM

BUILDING TRUST

TOOLS UTILIZED IN BUILDING TRUST & EMPOWERING PROFESSIONAL DEVELOPMENT AMONG COMMUNITY

PROFESSIONAL MAKING REFERRALS

• RECOGNIZE COMMUNITY MEMBERS SUPPORT A COHESIVE TEAM

• EMPLOY COMMITMENT

• SECURE ACCOUNTABILITY

• PROMOTE OUTCOMES

• CULTIVATE TRUSTWORTHINESS

THE TOP VIEW OF HOSPICE

WHAT MEDICARE HOSPICE MEANS • BENEFICIARIES DISCONTINUE CURATIVE CARE FOR THE TERMINAL ILLNESS AND INSTEAD RECEIVE PALLIATIVE CARE.

• CARE MAY BE PROVIDED IN A VARIETY OF SETTINGS, INCLUDING THE HOME, NURSING FACILITY, HOSPITAL, AND HOSPICE INPATIENT UNIT.

• THERE ARE FOUR LEVELS OF CARE, THE MOST COMMON OF WHICH IS ROUTINE HOME CARE. (ROUTINE, INPATIENT, CONTINUOUS & RESPITE)

• WITHIN EACH LEVEL OF CARE, MEDICARE PAYS HOSPICES FOR EACH DAY (PER DIEM) A BENEFICIARY IS IN CARE REGARDLESS OF THE QUANTITY OR QUALITY OF SERVICES.

PALLIATIVE CARE CONTINUUM

PALLIATIVE CARE AND HOSPICE CAN REDUCE THE OBSERVED SIDE OF THE EQUATION BY PREVENTING ADMISSIONS TO THE HOSPITAL AT THE END OF LIFE. A PATIENT BEING SEEN AND MANAGED BY PALLIATIVE CARE PROVIDERS CAN AVOID THAT LAST ADMISSION TO THE HOSPITAL IF PROPER PLANNING AND DIALOGUE WITH THE PATIENT, FAMILY AND CAREGIVERS TAKES PLACE.

• HOSPICE IN THE PINES HAS IMPLEMENTED A 911 EMS SERVICE AGREEMENT TO BE CERTAIN THE COHESIVE AND CONTINUITY.

DID YOU KNOW THAT BUILDING A COHESIVE TEAM WILL SUPPORT YOUR

SUSTAINABILITY?• THE VIEW OF HOSPICE TODAY IN A WORLD BESET WITH UNPRECEDENTED

ENVIRONMENTAL AND SOCIAL CHALLENGES MAY LEAVE MANY TO FEEL THREATEN AMONG THEIR LOCAL ECONOMY AND LOCAL COMMUNITIES.

• ACQUIRING RESOURCES TO HELP YOUR HOSPICE RE-ENGINEER ITSELF FOR SUCCESS, BEGINS WITH THE ALIGNMENT OF A GREAT TEAM.

• HOSPICE’S SHOULD EMBED SUSTAINABILITY FROM THE BOARDROOM TO THE COPY ROOM AND ALWAYS MANAGE THEIR ENTIRE VALUE CHAIN FOR SUSTAINABILITY….COHESION IS IMPERATIVE.

QUALITIESOF A

COHESIVE TEAM

ASSESS THE LEADERSHIP STRATEGIES UTILIZED AMONGIDT

(I LIKE THIS ILLUSTRATION BY MIA MACMEEKIN)

IDT(I LIKE THIS ILLUSTRATION BY MIA MACMEEKIN)

CHARACTERISTICS OF A COHESIVE TEAMKEY PRINCIPLES

COMMITTED TO COMMON GOALS AND OBJECTIVES

EXISTS IN A RESULTS-DRIVEN ENVIRONMENT

COMPETENT DISCIPLINARY MEMBERS

INTERDEPENDENT AND USE THE CONTRIBUTIONS OF ALL TEAM MEMBERS

TO ACHIEVE QUALITY RESULTS

DEMONSTRATE EFFECTIVE COMMUNICATION SKILLS

PROVIDE AN OPEN AND SUPPORTIVE CLIMATE

HAVE STANDARDS OF EXCELLENCE

EXPERIENCE EXTERNAL SUPPORT AND RECOGNITION

FORMING A TEAM TO ADDRESS THE ISSUE

• THE RIGHT PERSON ON AN IMPROVEMENT TEAM IS CRITICAL TO A SUCCESSFUL IMPROVEMENT EFFORT. TEAMS VARY IN SIZE AND COMPOSITION. EACH ORGANIZATION BUILDS TEAMS TO SUIT ITS OWN NEEDS.

• FIRST, REVIEW THE AIM / TARGET MARKET.

• SECOND, CONSIDER THE SYSTEM THAT RELATES TO THAT AIM: WHAT SYSTEM WILL BE AFFECTED BY THE IMPROVEMENT EFFORTS?

• THIRD, BE SURE THAT THE TEAM INCLUDES MEMBERS FAMILIAR WITH ALL THE DIFFERENT PARTS OF THE PROCESS – MANAGERS AND ADMINISTRATORS AS WELL AS THOSE WHO WORK IN THE PROCESS, INCLUDING PHYSICIANS, PHARMACISTS, NURSES, AND FRONT-LINE WORKERS.

• FINALLY, EACH TEAM NEEDS AN EXECUTIVE SPONSOR WHO TAKES RESPONSIBILITY FOR THE SUCCESS OF THE PALLIATIVE CARE PROJECT.

PSYCHOSOCIAL & CLINICAL ELEMENTS DEATH & DYING

* DEMONSTRATING THE BEST CARE FOR THE PATIENTS

* INDIVIDUAL DISCIPLINES

* COMPLIANCE OF NORMS

* ATTITUDE TOWARD DEATH & DYING

* WILLINGNESS TO DEFEND TEAM DECISIONS IMPACTING THE PATIENT

* SELF AWARENESS IS ESSENTIAL FOR SOCIAL WORK PRACTITIONERS, AND THAT COULD BE IDENTIFIED BY MANY DIFFERENT COMPONENTS, SUCH AS CULTURAL

AWARENESS…WHILE THE CLINICAL VIEW ASSESSES THE PHYSICAL COMPLEXITIES

EXPECT NOTHING LESS FROM THE LEADER

Assess and collaborate leadership strategies explicitly utilized among

interdisciplinary teams.

BEGIN THEMORTALITY CONVERSATION

• BACKGROUND: REDUCING LENGTH OF STAY (LOS) HAS BEEN A PRIORITY FOR HOSPITALS AND HEALTH CARE SYSTEMS. HOWEVER, THERE IS CONCERN THAT THIS REDUCTION MAY RESULT IN INCREASED HOSPITAL READMISSIONS.

• OBJECTIVE: TO DETERMINE TRENDS IN HOSPITAL LOS AND 30-DAY READMISSION RATES FOR ALL MEDICAL DIAGNOSES COMBINED AND 5 SPECIFIC COMMON DIAGNOSES IN THE VETERANS HEALTH ADMINISTRATION.

• CHRONIC DIAGNOSES (HEART FAILURE AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE) AND 3 ACUTE DIAGNOSES (ACUTE MYOCARDIAL INFARCTION, COMMUNITY-ACQUIRED PNEUMONIA

• THIS IS IMPORTANT BECAUSE HOSPITAL READMISSION IS BEING USED AS A QUALITY INDICATOR AND MAY RESULT IN PAYMENT INCENTIVES. FUTURE WORK SHOULD EXPLORE THESE RELATIONSHIPS TO SEE WHETHER A TIPPING POINT EXISTS FOR LOS REDUCTION AND HOSPITAL READMISSION

COHESIVE COMMUNITY PARTNERSHIPS

VICTORY OF TEAM COHESIVENESS

BEGIN YOUR RESEARCHMEASUREMENTS

• MEASUREMENT IS A CRITICAL PART OF TESTING AND IMPLEMENTING CHANGES; MEASURES TELL A TEAM WHETHER THE CHANGES THEY ARE MAKING ACTUALLY LEAD TO IMPROVEMENT.

• MEASUREMENT IS A KEY ELEMENT IN THE MODEL FOR IMPROVEMENT, A SIMPLE YET POWERFUL TOOL FOR ACCELERATING IMPROVEMENT THAT HAS BEEN USED SUCCESSFULLY BY THE INSTITUTE FOR HEALTHCARE IMPROVEMENT AND HUNDREDS OF HEALTH CARE ORGANIZATIONS IN MANY COUNTRIES TO IMPROVE NUMEROUS HEALTH CARE PROCESSES AND OUTCOMES.

THE IMAGE OF HEALTHCARE IN YOUR COUNTYCOMMUNITY

• WE HAVE EXCEPTIONAL HEALTHCARE PROVIDERS

• HOSPITALIST TO WORK WITHIN OUR HOSPITAL SYSTEMS

• SPECIALIST TO SUPPORT OUR DIVERSE POPULATION AND OUTLYING DEMOGRAPHICS

BUILDING & BRANDING

• DEMONSTRATE THE DIFFERENCE PSYCHOSOCIAL AND CLINICAL ELEMENTS ASSOCIATED INWORKING WITH DEATH AND DYING.

• IDENTIFY TOOLS THAT INFLUENCE PERFORMANCE AND ASSIST IN DESIGNING THE IDEALHOSPICE COMMUNITY BASED PALLIATIVE CARE PROGRAM.

• ANALYZE PROCEDURAL PROCESSES TO PROMOTE OPERATIONAL EFFICIENCY…

• (LEVERAGING BEST PRACTICES)

• CLASSIFY SYSTEMATIC APPROACHES SO YOUR PROGRAM WILL BE SUSTAINABLE ANDILLUSTRATE BEST QUALITY.

WE HONOR VETERANS

NOW GAINING PALLIATIVE CARE

REFERRALS • OPTIMIZING LEADERSHIP AMONG ALL YOUR MEDICAL / HEALTHCARE ALLIANCES

• EVALUATE ALL GAPS IN SERVICE WITHIN YOUR DEMOGRAPHIC AREA

• DEVELOP A SYSTEMATIC PLATFORM TO INITIATE REFERRALS ETHICALLY

• RE-EXAMINE YOUR PRACTICES AND DEFINE IMPROVEMENT MODELS

• COORDINATING & COLLABORATING WITH ACO’S, HOSPITALIST & NURSING FACILITIES

• OUR INDUSTRY IS HARD ENOUGH SO WE MUST BRIDGE THE GAP TO EMBRACE OUR PATIENT SERVICE POPULATION.

WHY WE DO WHAT WE DO REWARD

REMEMBERING THOSE WE SERVE

TNMHO & NHPCOMAKE AN IMPACT

NHPCO

SPECIAL THANKS ATTENDEES

WE ARE HONORED BY YOUR COMMITMENT TO HOSPICE CARE

Questions and Discussions