5/29/2015 ah HA! News and Updates from Hospice Analytics

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ah HA! News and Updates from

Research and Analytics to

Improve Hospice Care

Spring 2015

In This IssueQuick LinksFREE InfoMAX DemoRegister for Basecamp!New InfoMAX FeaturesHeadingOpportunities andAnnouncements

Quick LinksOur Web site homeNational HospiceLocatorInfoMAXInfoMAX pricing andorder formProducts & ServicesResources forOpposing Physician­Assisted Suicide About UsContact Us

FREE InfoMAX DemoWebinar, May 12

Attend a FREE, half­hour webinar to learnmore about the power ofdata in your managementand planning processes.This month, we'llexplore Discipline VisitNumber and DisciplineVisit Length­­what can

Our new logo and Web site design are done! Check it out here.It's not just window­dressing ­­ we hope we've made ourproducts and services more accessible and clear. A number ofthe changes were made because you asked . . . including anew feature in the newsletter called, "Since you asked . . ."which we hope will shed some light on interesting aspects ofusing and understanding data in hospice care. Let us knowwhat you think!

­­Cordt, Jennifer, Cathy, and Joy

Registration Now Open for Hospice Analytics"Basecamp," July 31 in Denver!

Hospice Analytics is offeringa day­long, hands­on"basecamp" for hospiceleaders and staff workingdirectly with our data orwanting to learn more aboutit. In a lively workshop format, we'll walk through how toaccess, understand, manipulate, and report essentialdata. Sessions will focus on utilizing data for financialand strategic planning, marketing, advocacy, andclinical services.

Earlybird registration is available until June 1, atonly $375.00, which includes your hotel stay over thenight of July 30 at the luxurious Woolley's ClassicSuites, breakfast and lunch on the conference day, allconference materials, complimentary reception theevening of July 30, and free transportation to and fromDenver International Airport. Register nowSpace is limited!

Opportunities to Help Hospitals withReadmission Penalties

Reducing readmissions of patients to hospitals within 30days of discharge is a top priority in healthcare reform,

5/29/2015 ah HA! News and Updates from Hospice Analytics

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these data tell you aboutyour program vs. othersin your area, utilization ofresources, clinicalservice model, andcompliance? May 12, 3:00PM EST(12:00PM Pacific). To register, send an email to JenniferBallentine

Hospice AnalyticsInfo

Our MissionHospice Analytics is aninformation­sharingresearch organizationwhose mission is toimprove hospiceutilization and accessto quality end­of­lifecare through analysis ofMedicare and othernational datasets. Collaboration withState Hospice Orgs More than 50 percent ofthe State HospiceOrganizations participatein Hospice Analytics'Market Reports Project.These State HospiceOrganizations representover 60% of the hospicesserving over 70% of thehospice patients in thecountry. Substantialrevenue is shared withparticipating non­profitState Hospiceorganizations.

Our Staff Cordt Kassner719­209­1237

Jennifer Ballentine303­521­4111

Cathy Wagner303­238­5394 Joy Berger502­593­3916

both to improve quality of care and to reduce costs.Since 2012, hundreds of hospitals across almost all 50states have been financially penalized for high rates ofreadmissions. Many facilities and systems have beenworking to develop patient discharge and transitioninterventions to decrease readmissions, especially amonghigh­risk, high­intensity (and thus high­cost) patientpopulations. There is an opportunity here for hospiceand palliative care programs. Factors contributing toreadmissionNationally, the averagereadmission rate is 24.10%, andmany systems have madesuccessful efforts to reducerates. Study data andconclusions vary; however, ameta­analysis[i] of 34 studiesshowed that a median 27% ofhospital readmissions arepreventable (range 5% to79%). Factors contributing to30­day readmissions include

premature discharge or inadequate post­dischargesupport; insufficient follow­up; failed handoffs to primary care providers; complications from procedures; infections, pressure ulcers, and patient falls; andtherapeutic errors, many involving medications.

In particular, polypharmacy, certain high­riskmedications (including narcotics, antipsychotics, andantidepressants), more than six comorbid chronicconditions, and specific clinical conditions (includingCOPD, heart failure, cancer, and stroke) have beenidentified as high risk factors for readmission. InterventionsNo one reliably successful intervention to reducereadmissions has been found, but the most effectiveprograms are multifaceted, complex, and gearedtoward supporting patient self­care, according to theauthors of the meta­analysis. The best models oftencombine nurse­led care coordination with telephonicsupport and frequent home visits. Opportunities for hospice and palliative careLooking at these risk factors, hospice and, in particular,

5/29/2015 ah HA! News and Updates from Hospice Analytics

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Hear What OurClients Are Saying!

We have really come toappreciate you and theservice you provide. It'sbeen invaluable to ourwork!

­­Hospice CEO (TX) This is really wonderfuldata! The report . . . hasreally helped our Board topicture where we are andwhere we need to go asan organization.

­­Hospice ExecutiveDirector (NY)

I like your reports andfind them invaluable toour business develop­ment work. Keep up thegood work!

­­Hospice BusinessDevelopment Manager

(WA)

Speaking & Teachingby Hospice Analytics

Hospice Analytics hasoffered workshops andplenary sessions on dataanalysis and utilization,strategic planning, andother topics at numerousstate and nationalconferences. To arrangean engagement in yourstate or agency, contactJennifer Ballentine .

May 20Hospice Federation ofMassachusetts AnnualMeetingJennifer Ballentine

May 21Hospice & Palliative CareAssociation of New YorkState AnnualInterdisciplinarySeminar and MeetingCordt Kassner

community­based palliative care programs are ideallysuited to helping hospitals with their readmissionschallenge. Hospice and palliative care (HPC)programs can position themselves to receive high­risk, high­intensity patients with multiple or advancedillness, for instance, by

specializing in care of patients with COPD, heartfailure, or cancer; partnering with hospitals to provide or participatein palliative consults; and arranging post­discharge transfer to an HPCprogram. HPC can then fully coordinate care forthese complex patients.

HPC medical directors can review medication lists,focusing on those most essential for symptom controland comfort, and nurses can assist with patient educationand support patient self­care and caregiving. How InfoMAX Can HelpPremier InfoMAX subscribers can find severalreports to that will help identifyopportunities: Hospital, home health, and skillednursing facilityadmissions diagnoses reports canidentify patient populations at riskfor readmission. The HospitalPalliative Care report identifieshospitals that are doing palliativecare consults­­which can oftenlead to a hospice referral. It canalso identify hospitals that are notdoing palliative care consults­­which provides an opportunity forhospice help build a consultoption. As the pressure mounts onhospitals and systems to further reduce readmission,HPC can thus be valuable partners in improving patientcare and reducing costs.

[i] Alper, E., O'Malley, T.A., & Greenwald, J. (2014). Hospital discharge andreadmission. Up To Date report. http://www.uptodate.com/contents/hospital­discharge­and­readmission

"Since You Asked . . . "

The Hospice Analytics team is available to answer questionsat any time. It's occurred to us that your questions­­and ouranswers­­might be interesting to others in the field. So we'readding this new feature to our newsletter. Each month we'llshare a question and an answer. Let us know what you think!

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How is average length of stay calculated?You wouldn't think this would be a stumper, but it is.Hospices (and payers and FIs) calculate mean length ofstay (LOS) at least a dozen different ways. Here aresome examples:

1. Hospice Analytics uses calendar year Medicarehospice claims for all beneficiaries, which equalsthe total days of care divided by the totalnumber of beneficiaries. We can then use thismethod for a beneficiary, a hospice, a county, astate, or the country. This allows us to comparechanges in LOS across different calendar years.

2. MedPAC first narrows their sample to onlyMedicare beneficiarieswho have died, then looksacross the lifetime totaldays of hospice care perbeneficiary.

3. NHPCO reports using acombination of NationalData Set results andMedicare claims. Morerecently it appears they rely more on NDS results;so LOS as self­reported by 12% of hospicesnationally who complete the survey.

4. Some hospices pick a month and divide days ofcare by beneficiaries served.

5. Some hospices will track all patients admitted inJanuary through discharge, and average theirdays.

6. Some hospices will only include patients whodied in their program during the calendar year,and do the calculation.

All of these methods are "right" as long as the numeratorand denominator are clearly defined. If your LOScalculation is different from someone else's, double­check how LOS was defined.

Opportunities and Announcements

Sarah Bealles to lead innovative merger of threepalliative and end­of­life care providersIf you attended our Evidence­based Leadership Summit inJanuary, you'll remember that Sarah Bealles, then CEO ofJourneyCare in Illinois, discussed how she has used InfoMAXdata to understand opportunities for mergers and acquisitions. Recently, it was announced that JourneyCare is joiningHorizon Hospice & Palliative Care and Midwest Palliative &Hospice CareCenter to form the largest nonprofit palliative,supportive and end­of­life care provider in Illinois. Altogether,

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the new entity will comprise 800+ employees and care forthousands of patients in Chicago and 10 surrounding counties.Sarah will serve as President and CEO of the new, yet­to­benamed organization. More information this excitingdevelopment can be found here. IOM Releases PSA About Having a Conversation onEnd­of­Life CareMore than a quarter of all adults have given little or no thoughtto the care they would want to receive if seriously ill or nearingthe end of life. The Institute of Medicine has created a newpublic service announcement and website on when and howto start that conversation with friends, family, and careproviders. The 30­second PSA can be viewedat www.iom.edu/theconversation, which also lists resourcesfor having a conversation about end­of­life values, goals, andpreferences. Resources to Oppose Physician­Assisted SuicidePhysician­assisted suicide (aka "physician aid in dying,""physician­assisted death") bills have been introduced in 14states: California, Connecticut, Colorado, Iowa, Kansas,Missouri, Maryland, Massachusetts, Montana, New Jersey,New York, Oklahoma, Utah, and Wyoming. The Coloradobill was defeated in committee and the Wyoming and Montanabills have been tabled. Several other states have proposals ordrafts in process, and lawsuits challenging laws prohibitingPAS have been filed in New York and California. If it hasn'talready, this issue will soon come to you, and everyhospice professional and agency will be called upon to provideaccurate information, distinguish hospice from assisted death,and reassure patients and families that relief of suffering isboth our specialty and our top priority. Hospice Analytics hasbeen following this issue very closely and has assembledcopious fact­based information as well as model positionstatements and legislative recommendations. Because thereappears to be no national clearinghouse or centralizedorganization opposing PAS, we have assembledopposition resources on our Web site. For more information,contact Jennifer Ballentine, 303­521­4111.

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Colorado Springs, CO 80919

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