The Gentle Art of Teaching Hospital CEOs

By Sue Lyn Schramm, Principal

One of the challenges for hospice and palliative leaders has always been that their services were seen as a small part of the healthcare continuum. Over and over, I’ve had hospice CEOs and administrators tell me their greatest frustration was getting the time of day from hospital and health system execs.

Lately, however, I’m not hearing that as much. Instead, I hear clients and friends telling me their local system seems interested in post-acute care in a new way. This January, the Society for Healthcare Strategy & Market Development published results from a survey of hospital and health system executives, CEOs and CFOs, mostly. They were asked how likely is it that by 2023, "Your hospital or health system will increase its collaboration with other providers (e.g. doctors, hospitals, post-acute care organizations) and payers on population health management as a strategy to improve clinical outcomes.” Fully 94% of them said it was Likely. 71% of them even said “Very Likely.”

The reason for this new attention to post-acute care is that hospital payment incentives are strongly encouraging acute care providers to care about what happens after patients are discharged from the hospital more than ever before. This hasn’t always been the case. Jeff Goldsmith, a well-known healthcare futurist, wrote about this issue: “Traditionally, the hospital’s responsibility ended abruptly upon discharge. In candor, the discharge process often was not focused on patient outcomes. In many institutions, the main focus was on clearing the bed and making sure the patient had a safe ride home.”

Now however, inattention to what happens immediately after an acute care episode can cost the hospital, health system or ACO money. If the patient comes back as a re-admission or Emergency Department visitor, that’s bad, not only for the patient, but also for the at-risk provider’s bottom line.

Cost avoidance is the name of the game, and post-acute care is finally getting its due as a key component in improving outcomes and reducing costs. Unfortunately, that doesn’t always mean that the hospital CEOs know clearly what they want or need from hospice. Nor does it mean they always have a good understanding of why hospices can make vital partners in a health system’s efforts to reduce costs of care.

Hospice leaders may find themselves in the position of (gently) helping their local hospitals and health systems to understand the new imperatives of managing costs when revenue is at risk. After all, managing patient costs on a fixed payment is something that the hospice industry has been doing since 1983.