New hospice leaders have indicated that workforce development, efficient technologies and growth in home-based services represent key focus areas for providers during the next few years. Meanwhile, their biggest challenges include regulatory and reimbursement shifts.
Hospice News recently sat down with two new hospice executives to discuss some of the biggest opportunities and concerns on the horizon in end-of-life and serious illness care.
Skelly Wingard, became CEO of By the Bay Health in June. Earlier in the year, Yonah Klein was appointed director of strategy at Unity Hospice and Palliative Care.
Technology a key to growing home-based hospice care, workforce
The future of end-of-life care is heading further into the home, according to Klein. This creates opportunities for hospices to delve deeper into home- and community-based care, he said. In doing so, pouring resources into education and outreach will be important.
“Home is in general the future of the health care landscape. We’re not just seeing this in hospice, but also in the hospital-at-home space and other areas of health care,” Klein told Hospice News. “People want to be cared for in the comfort of their own home, wherever they may call home. It’s the ideal place for one to pass. It also keeps people out of the hospitals and from overcrowding. This level of care is really a win-win for everyone.”
Education and outreach will be important pieces of supporting rising demand for home-based hospice care as more people reach a need for end-of-life support without sufficient insight around this care, Klein stated.
Klein became CSO at Illinois-headquartered Unity Hospice and Palliative Care in May. He previously served as the hospice organization’s corporate director of business development since 2020. Klein now leads Unity’s development and implementation of strategic initiatives, working with its senior leadership team and external partners to identify opportunities for growth and innovation in hospice and palliative care.
Established in 1992, the family-owned and operated nonprofit provides hospice and palliative care in Indiana, Missouri and in its home state of Illinois. Part of Klein’s family members were involved in starting the organization, he stated.
A common thread since the hospice provider first launched services in 1992 has been growth focused on expanding services to communities that are unaware and in need of end-of-life support, according to Klein. Unity Hospice and Palliative Care recently added Houston, Texas, to its service region following its acquisition of an existing license in that market.
“The goal is really to further expand [and] saturate our services throughout our current markets, particularly on the education piece of hospice and palliative care,” Klein stated. “We’re really looking to further saturate and [also] expand to other areas where we feel hospice is just underutilized.”
Expanding outreach efforts to existing and new referrals is one key to improving patient access, while educating underserved communities is another, according to Klein.
“Unfortunately, a lot of people and most elderly people who are eligible for hospice and palliative care don’t really receive this great level of care,” Klein said. “Most don’t even know about it, even if they do quality for it. So, [it’s] really continuing to educate and just being a credible hospice.”
Technology is a key piece of strengthening hospices’ evolving presence in the community- and home-based health care realm, according to Wingard.
“[It’s] just being very interested and comfortable with getting as innovative as possible with [artificial intelligence (AI)] and future technology models and applications that would apply in home-based care,” she told Hospice News. “Leveraging data and technology to build efficiencies and advance quality, those are areas where innovative growth can apply.”
A strategic roadmap
California-based By the Bay Health tapped Wingard to fill the CEO role in June upon the retirement of Kitty Whitaker, who had led the hospice organization since 1996. She most recently served as vice president, continuum of care at Kaiser Permanente, holding the same role at Ensign Services Inc. prior to that.
Established more than 45 years ago, the nonprofit organization now serves eight counties statewide and provides hospice palliative and pediatric care, as well as grief support and skilled home health care.
In recent times, recruitment and retention issues have been a forefront concern, largely due to growing numbers of retirees and high turnover rates spurred by during the pandemic.
Building up workforce and technical capabilities will be two important focuses in the future of hospice care delivery, according to Wingard. Investing in both innovative technologies and organizational culture are among the largest levers for hospices to pull in coming years, she indicated.
“It’s anything you can do to lighten their workloads and create as many efficiencies as possible so that clinical teams can spend more time at the bedside with patients and families,” Wingard said. “If there’s technology to support that effort, it’s something to engage in, because the world of hospice can be very taxing on caregivers.”
By the Bay Health is currently developing a five-year “strategic road map” designed to address the needs of staff, according to Wingard. The design comes with an “intentional, people-centric focus” on including team members from different operational areas to ensure various perspectives are represented, she explained. Considering employee feedback can help hospices to strategize organizational culture and technology support structures that both build and grow workforce relationships, Wingard explained.
“You want to make your workplace truly the best environment for your workforce,” Wingard said. “It’s about making sure the people-centric, mission-driven culture of the organization carries on and is codified in future generations. And that will come from supporting every person in an organization and having representation from that staffing area involved in discussions on how support develops.”
The biggest hurdles: reimbursement, regulation
A move towards value-based care models is an emerging disrupter in the hospice community, according to Wingard.
Hospices to date have primarily engaged with private health plans through diversified programs such as palliative care, PACE and other services. However, the ongoing value-based insurance design model (VBID) demonstration and payment arrangements with Accountable Care Organizations (ACO) will continue to impact hospice reimbursement.
Hospices can likely expect “a huge shift” in both payment and the types of services patients may receive, Wingard said.
“There are many ways a health benefit like hospice can be managed with phenomenal use of services,” Wingard told Hospice News. “We can embrace those reimbursement shifts. But if it becomes over-managed with several gatekeepers, then we might see a dramatic shift in services provided or allowed to the patient. And that’s a caution for us all to recognize. We should all get to experience a death where our choices are honored, and it would be a shame if people were not allowed to use the benefit to its full entirety at the end of their life.”
Heightened regulatory oversight is another challenge hospices will continue to face, according to Klein.
Case in point, regulators have strengthened program integrity efforts for the Medicare Hospice Benefit in response to a rash of newly licensed hospices selling off these assets in California, Nevada, Texas and Arizona in recent years.
The U.S. Centers for Medicare & Medicaid Services (CMS) in its proposed home health rule for 2024 introduced the hospice provision of a 36-month change of ownership regulation. The rule prohibits any change in majority ownership during the 36 months after initial Medicare enrollment, including acquisitions, stock transactions or mergers.
A flurry of merger and acquisition activity in the hospice space has left “lots of gaps of care” among some regions experiencing “constant buyouts” and changes of ownership, he said.
“Unfortunately, a lot of companies who aren’t in it for the long-run can create additional regulatory oversight, which sometimes can ruin it for the other companies who are in it for the quality of care,” Klein told Hospice News. “At the end of the day, it’s the quality of care that suffers is a continued factor that the industry deals with.”