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The hospice & palliative care industry is hyper-competitive and dominated by hospital & large health care systems as well as multi-state & national hospice agencies.

Independent agencies often lack the resources to get their message out and compete for referrals.

Recently yet another article was published and is making the rounds stating that patients have a choice, that hospital discharge planners must make neutral referrals to hospice & home health providers. The guidelines from CMS, The Centers for Medicare and Medicaid Services are clear.

42 CFR § 482.45 (7)

“The hospital, as part of the discharge planning process, must inform the patient or the patient’s family of their freedom to choose among participating Medicare providers of post hospital care services and must, when possible, respect patient and family preferences when they are expressed. The hospital must not specify or otherwise limit the qualified providers that are available to the patient”

Knowing that discharge planners are supposed to be neutral does not provide your hospice agency with any tools to generate more referrals. Furthermore, hospice agencies don’t want discharge planners to be neutral, you want them to send your agency referrals. How does it help your agency if discharge planners are neutral and your agency still does not get referrals from that hospital or health care system?

Everyone who works in hospice knows, especially the marketers/liaisons who are in the field every day working to generate referrals, hospitals and other health care systems that have their own or affiliated agency keep many of those referrals in house. The referrals that aren’t kept in house often get picked up by the large branded agencies that have the scale to build a big brand name.

Even worse, it’s only getting harder for independent agencies to get referrals from large health care systems. Between 2000 and 2015 the proportion of US hospitals with more than fifty beds that had palliative care programs tripled, from 25 percent to 75 percent, according to this Health Affairs article.

What is a local independent agency to do?

Stop the Blame Game

Patients, and their caregivers, have a lifetime of training by insurance companies to choose their in-network provider. For the vast majority of patients, deciding where to go and which doctor, testing facility, and other care provider revolves around in-network vs out of network not who delivers the best care. Even when a patient stays in-network, often hidden bills for specialists and other care providers that are not part of the network pop up after the fact, such as when an outside specialist delivers care at an in-network location.


It is overwhelming for patients and their caregivers to navigate the labyrinth of networks, providers, paperwork, bureaucracy, and billing while managing a disease. One of the most common reactions from families during an initial hospice consult is “You mean I don’t need to organize care and fill out forms and deal with insurance? You guys will really handle all of that? Thank God!”

Patients and caregivers are stressed out, exhausted, and suffering and cannot be expected to know the details of the hospice & palliative care and how that works with Medicare, Medicaid, and private insurance. Many patients and caregivers make their choice in a difficult moment with limited knowledge of how hospice happens. Even if your agency is one of the three names on the list a discharge planner neutrally hands a patient and even if the patient realizes they have a choice, that is still no reason for them to choose your agency. The path of least resistance is to continue with the same health system ‘name.’

Continuing with the familiar is a powerful barrier to entry that requires significant time, energy, and resources to overcome.

However, focusing on the point that patients have a choice implies that the discharge planners or even the patients have done something wrong by not choosing you.

The important question is: what has your agency done to differentiate your agency and deliver real added value to not just get on the list, but to be a preferred provider?

There is no ROI (return on investment) in complaining that discharge planners or other referral sources aren’t “neutral”. Tangible ROI comes from differentiation and delivering value.


Wholesale vs. Retail

In order to capitalize on the point of ‘patient’s choice’, patient’s need to know your agency. Just being on a list with names they do recognize, such as a hospice with the same name as the hospital they’re in, will not noticeably increase your referrals. While marketing directly to patients and the community at-large is important it is an expensive effort. Local and independent agencies often lack the money, time, energy, and knowledge to effectively market themselves to the general public. Even worse, smaller agencies waste their limited resources pushing the “Patients’ Choice” mantra and have their efforts drowned out by the large Multi-State & national brands.

Further, marketing hospice to the general public (B2C) in order to be chosen by a patient must be a continuous non-stop effort. Hospice is not a product like a brand of soda or cell phone that can lock in a regular repeat customer. There are very few repeat customers in hospice.

Independent agencies are better served focusing their resources on wholesale referrals (B2B) to generate 10 referrals from one provider rather than 10 individual self-referrals from the general public.

Palliative Care as your Competitive Advantage

Most hospice agencies already have the resources in terms of clinical staff and logistics to offer palliative care. Instead of competing on marketing dollars which is a losing proposition, independent and local hospice providers can differentiate themselves to hospitals and health care systems by offering palliative care. Hospital palliative departments are typically focused on hospice. Hospice has greater revenue and hospitals already have the infrastructure for inpatient units. However, given the lower revenue per patient and the shortage of palliative clinicians, these healthcare systems are often interested in outsourcing palliative. Offering palliative care becomes a lead-in for hospice, making you a preferred provider on the discharge planner’s list for palliative and hospice and many palliative patients will become hospice appropriate.

Hospitals also see the benefit of palliative care. Recent studies indicate that by improving their quality of life and quality of care, palliative care can also provide substantial cost reduction.

Research by the national polling firm Public Opinion Strategies reveals that even for those patients who are uninformed about palliative care, once they understand what it is, 92% report they would be highly likely to consider palliative care for themselves or their families if they had a serious illness. Read the article here.

study in Health Affairs found that Medicaid patients at four New York state hospitals who received palliative care on average incurred nearly $7,000 less in hospital costs per admission than Medicaid patients who didn’t receive palliative care. This study supports the results of a 2008 Archives of Internal Medicine study of non-Medicaid patients at eight hospitals that showed average savings of about $1,700 for those who survived a hospital stay and $4,900 for those who did not.

The benefits of palliative care include significant improvements in quality of life and symptom control while reducing costly hospital readmission and urgent care. These studies have also documented prolonged survival for those receiving palliative care.

Unfortunately, lack of cohesive and organized palliative care standards, regulations, benefits, and billing prevent many hospice providers from offering this much needed and differentiated service.

Get Started with Palliative Care

A stumbling block for many hospice agencies in offering palliative care is the lack of back office palliative care resources and rigid legacy EMR systems that are not built for palliative care. Many agencies try to use a home health module of their cumbersome EMR to chart their palliative care and struggle with their palliative billing and revenue management.

Hospice Tools is built from the ground up by management and clinical care experts in hospice & palliative care. Our expertise enables us to deliver user-friendly palliative care charting and billing.

Take a look at how Hospice Tools flexible EMR simplifies palliative care management:

1.  Select Visit Type & Location & complete relevant fields of the Palliative Care Consultation form, e-sign & submit

Forms, form functionality, & workflows can be customizedPalliative consult form

2. In the Patient’s chart click the Palliative tab, select the completed palliative consult form and under CPT codes click ADDPalliative CPT section 3. Recommended CPT codes based on home or facility location will pop up.
Simply select the relevant CPT code, click OK and mark completePalliative recommended CPT codes 4. Enjoy the increase in referrals that comes with offering palliative care with the simplicity and efficiency of the Hospice Tools Flexible EMR

Hospice Tools is cloud based with full functionality in both web browser and native mobile apps for Android & Apple devices!

Hospice Tools flexible EMR is built from the ground up for hospice & palliative care. Get user-friendly charting, massive efficiencies, automatic compliance and much more!

Click the Demo Tab to check out our video library or see Hospice Tools in action with our No-Risk Free-Trial!

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