PDGM ‘Not as Tough as It Was Cracked As much as Be’: Longtime Hospice Supplier Enters Residence Well being Market – Residence Well being Care Information


To borrow from “A Story of Two Cities,” it’s the very best of occasions and the worst of occasions for a supplier to be getting into into the house well being area.

On one hand, COVID-19 — and the enterprise and scientific issues that include it — pose unprecedented day-to-day challenges. As the most important fee overhaul in 20 years, the Affected person-Pushed Groupings Mannequin (PDGM) presents its personal nuanced hurdles as effectively. 

But alternatively, extra sufferers and households need to be handled within the security of their very own properties than ever. And even earlier than COVID-19, the U.S.’s ageing inhabitants and the cost-saving capability of home-based care have been offering tailwinds for suppliers of all sizes and shapes.

Hospice by the Bay — a longtime supplier of hospice care in San Francisco — is at the moment studying about that duality firsthand. Three years in the past, it tentatively started exploring house well being in an effort to finally set up a continuum of care inside its community, successfully assembly sufferers earlier on of their care journey.

“We determined a few years in the past that we wished to develop the best way that we have been interested by delivering care at house, and we wished that to incorporate house well being care,” Hospice by the Bay CEO Kitty Whitaker advised Residence Well being Care Information. “We felt that we have been ready to have the ability to do that, as a result of we’ve been delivering care within the house for about 45 years.”

Based in 1975, Hospice by the Bay was the primary hospice supplier in California and the second in the complete nation. It has a complete census of round 1,000, with its house well being arm accounting for nearly 300 sufferers. Together with house well being and hospice, the company additionally gives palliative care and bereavement providers.

Hospice by the Bay’s entrance to house well being was deliberate, but it surely was meant to be taken slowly. As soon as two businesses inside its footprint have been available in the market to be acquired, nonetheless, issues started transferring quicker. First got here InCare Residence Well being in October 2017, then Therapeutic at Residence a 12 months later.

With these acquisitions, Hospice by the Bay introduced on advising house well being administration and extra employees. Rapidly, Hospice by the Bay was as a lot a house well being operator because it was a hospice supplier.

Constructing a one-stop store

The swift motion on house well being — and the general imaginative and prescient — has ended up paying dividends. Since Might, Hospice by the Bay’s house well being census has elevated by 25%.

Along with its entrance into house well being, Hospice by the Bay can also be anticipating tailwinds from different post-acute care developments: explosive development in Medicare Benefit (MA) and rising demand for palliative care amongst them.

“We’ve been fairly deliberate in our strategic initiatives,” Whitaker stated. “We’ve made intentional, strategic selections that we expect [align us] with the way forward for well being care. … We’re having to work extra with the Medicare Benefit packages. And they are going to be trying to work with organizations like ours which have totally different service strains which can be a one-stop store for them. And we’ve got intentionally actually tried to set ourselves as much as be prepared for that.”

Aiming at being on the frontier of the way forward for well being care began with house well being, but it surely didn’t finish there. 

Pairing palliative care with its house well being and hospice service strains is smart from a scientific standpoint, Whitaker stated. At this level, it’s extra about ready for the best fee fashions that reward good palliative care to take form.

“The Medicare Benefit packages — and personal insurance coverage generally — have proven an actual curiosity in palliative care, whereas Medicare to a point has type of sat on its fingers,” Hospice by the Bay CFO Denis Viscek advised HHCN. “However I feel the personal insurance coverage and Medicare Benefit packages see it as an actual worthwhile profit to their sufferers and beneficiaries.”

Ultimately, Viscek believes that palliative care might enormously outpace the hospice market within the U.S., which he told HHCN sister site Hospice News in December.

Palliative care in the US has been steadily growing this century, rising by 178% in hospitals from 2000 to 2016, in line with the 2018 Palliative Care Growth Snapshot issued by the Center to Advance Palliative Care (CAPC).

Group-based palliative care is changing into extra prevalent as effectively, particularly since these kinds of providers turned reimbursable via MA plans. That gives a chance for businesses like Hospice by the Bay to step in.

Greater than 60 MA plans throughout the nation are providing in-home palliative care as a supplemental profit in 2020.

The challenges of house well being

Whereas COVID-19 has been a problem, it has additionally clearly added curiosity in Hospice by the Bay’s house well being enterprise.

However the firm didn’t skate by with none assist. To be able to preserve all of its employees on board, which it did, Hospice by the Bay utilized — and acquired — upwards of $5 million in Paycheck Safety Program (PPP) cash, in line with publicly accessible knowledge from the Small Enterprise Administration (SBA). 

And residential well being’s boogeyman — PDGM — was daunting in idea, however not in follow.

“PDGM was not as troublesome because it was cracked as much as be,” Viscek stated. “It was definitely a change. However we weathered that fairly effectively. And one purpose we weathered it fairly effectively is that we weren’t pushed by remedy earlier than.”

As an alternative, for a longtime hospice supplier, the principle problem was extra of a mindset-related one. It wasn’t about simply studying PDGM, but additionally embracing the skinny margins that include house well being, usually.

“We needed to be taught instantly with PDGM,” Whitaker stated. “I additionally assume that it’s good to actually have a look at this service line as one the place you’re not going to have big margins, and it’s good to be okay with that. You really want to have a look at it as being a part of your system of care.”

As a result of house well being margins are skinny, the corporate is investing in areas it by no means has earlier than, like intensive, technology-driven knowledge monitoring.

It’s at the moment constructing out its knowledge plans via software program firm Epic’s expertise.

“There’s actually two elements to the info,” Viscek stated. “One is the metrics essential to handle the enterprise effectively. We’re forward of that sport — we began that course of six or eight months in the past. … The second is the info that we have to give to payer sources on why to decide on us and why contract with us. And we’ve managed to get that kicked off just lately.”

The one factor holding Hospice by the Bay again from it’s house well being future now’s Hospice by the Bay — its title, that’s. 

“Taking hospice out of our title will permit us to higher appeal to referral sources that actually perceive that we’re a company that has these totally different techniques of care that we are able to ship at house,” Whitaker stated.

A reputation change is underway, however for now, it’s secret.