National health care policy is focused on eliminating fraud, protecting patients and ensuring high quality care. The heightened scrutiny created by today’s evolving regulatory environment provides all health care providers — including hospice — with an opportunity to shine in a competitive market. Benchmarking is essential to ensure compliance, gauge performance, identify areas for improvement and consistently deliver high quality care.
A unique aspect of hospice is that we have only one opportunity to get it right — there are no second chances in end-of-life care. We provide the comprehensive web of physical, spiritual and psychosocial support that patients and families need during this vulnerable time. They place their trust in us. It is a commitment that we take very seriously.
In Northern Ohio alone, there are more than 40 hospice providers: nonprofit, for-profit, system-owned, etc. So, what are the standard “industry benchmarks” for hospice, and how does hospice in Ohio measure up? In a 2013 report based on data from Centers for Medicare and Medicaid Services, Ohio’s nonprofit hospice organizations excelled in several key performance categories:
Patients discharged alive from hospice — if a high percentage of patients are discharged alive from hospice, it could indicate that a hospice organization is transferring higher-cost patients to Medicare. The live discharge rates for Ohio’s nonprofit hospices is 6.7 percent, well below the Ohio and national averages of 22.2 percent and 19.5 percent, respectively. Hospice of the Western Reserve’s average is 5.6 percent.
Length of stay — Patients with prognoses of six months or less are encouraged to seek hospice care. Hospices that have a high proportion of patients with exceptionally long lengths of stay may be admitting patients who do not meet the hospice eligibility criteria. While predicting a person’s life expectancy is an inexact science, some hospice organizations abuse the Medicare hospice benefit by routinely admitting patients with low cost of care and prognoses measured in years.
CMS data on the average length of stay in hospice within the state of Ohio is particularly troubling; the average length of stay for patients at for-profit hospices is 360 percent longer than at nonprofit hospices.
Hospice performance is also gauged through regular inspections and surveys:
State and national inspections — Hospice of the Western Reserve is a Medicare-certified hospice and, as such, must undergo regular inspection by the Ohio Department of Health. We also voluntarily participate in routine inspections by the Joint Commission, an independent, nonprofit organization which accredits and certifies more than 20,500 health care organizations and programs in the United States. Joint Commission accreditation and certification is recognized nationwide as a symbol of quality that reflects an organization’s commitment to very high performance standards.
Feedback surveys — Pain and symptom management and participation in decision-making are vital for patients and families, so hospices monitor and evaluate patient and family feedback in these areas. Concurrent surveys are conducted within the first 10 days of admission to hospice for patients who are cared for at home. This valuable feedback guides hospices to strive for continuous improvement.
The results of Hospice of the Western Reserve’s Concurrent Surveys are updated quarterly on the website: www.hospicewr.org. We were also recently presented with an award of excellence for attaining the 95 percent percentile of national family satisfaction scores. As the data from many sources show, Ohio’s nonprofit hospice organizations rise to the top in the measures of high quality in hospice care.