Quality Quarterly

Hospitals Have Opportunities to Protect Patients Receiving Hospice Care 

Hospice care organizations provide services for the most vulnerable among us — those who are terminally ill and often wholly dependent on family or caregivers. Regrettably, among vulnerable populations, there is a concern about exploitation. The popular 2020 Netflix film “I Care a Lot” delves into a fictional narrative, unveiling fraudulent health care schemes targeting elderly, vulnerable patients. While fiction, it serves as a thought-provoking glimpse into the real hazards and fears patients may encounter in their pursuit of quality health care. 

Hospitals play a pivotal role in shielding patients from fraudulent hospice care practices by fostering trusted partnerships with service allies. On Nov. 8, a CHPSO webinar, “How to Protect Patients and Ensure Operational Success,” provided a look at the role hospitals can play in offering care and support. Led by Sarah McSpadden, CEO of The Elizabeth Hospice, and Robin Smith, director of post-acute care services and partnerships at UC San Diego Health, the webinar highlights the power of meaningful collaborations in ensuring safe, comprehensive, and patient-centered care. The webinar detailed tactics to identify and avoid hospice fraud, offering proven strategies that enhance the patient experience and improve hospital quality metrics. 

In March 2022, prompted by an upswing in hospice care complaints, the state conducted a comprehensive audit of hospice agencies. The findings detailed a variety of patient safety concerns attributable to inadequate oversight of hospice providers and licensing procedures. To help address these issues, the HQI and CHPSO webinar also offered lessons learned from the state audit and best practices for organizations providing end-of-life and palliative care. Strategies discussed during the webinar include: 

  • Examination of currently offered hospice services, including general inpatient hospice 
  • Evaluation of existing referral and enrollment workflows 
  • Exploration of mechanisms for escalating concerns related to hospice services 
  • Establishment of organizational goals for hospice and palliative care 
  • Identification of necessary executive sponsors and internal leaders to achieve set goals 

Along with these strategies, the webinar provided a look at an ideal future state for improved hospice care that includes: 

  • A defined level of hospice care provided to patients  
  • Clarification of the organization’s role 
  • Specification of the role of the hospice/palliative agency 
  • Establishment of criteria for determining goal achievement (quality metrics/data capturing) 

The webinar underscored the importance of an elevated collaboration among hospitals and hospice agencies. This involved the integration of clinician tools into electronic health records, assessment and enhancement of workflows, and streamlining of referral processes. The outcome of these measures was an elevated sense of dignity for patients in the receiving end-of-life care, complemented by improved bereavement support for their families. 

Hospitals that adopt recommended strategies stand to gain improvements in quality metrics, such as reductions in readmissions, length of stay, and mortality rates, which can all lead to substantial cost savings. 

For additional information on hospice care, the National Institute on Aging, a division of the National Institutes of Health, is an excellent resource. CHPSO members seeking access to exclusive information can contact info@chpso.org. For non-members interested in learning more about protecting patients from hospice fraud, visit the prospective members section of the CHPSO website.