Netsmart CareThreads
Netsmart CareThreads

Episode · 11 months ago

7. #hospice and #palliative NHPCO CEO Edo Banach’s Guidance for Navigating the Path Forward

ABOUT THIS EPISODE

Along with a pandemic and a contentious election, hospice leaders have to navigate new payment models, diversify and expand services, protect the health and safety of patients and staff, meet new regulatory challenges, and leverage technology to deliver care virtually. 

  

How do we navigate the path forward? 

  

In this episode of Netsmart CareThreads, we asked Edo Banach, president and CEO at National Hospice and Palliative Care Organization, for his thoughts.  

  

Here's what Edo said: 

  

- How technology helps provision hospice and palliative care 

  

- Why the future may lie in person-centered interdisciplinary care 

  

- How the Medicare Advantage plan can affect patient perceptions of choice 

  

- Ensuring that current community palliative care providers remain relevant for serious illness care at the state level 

  

- Alternative payment structures 

  

If you want to hear more episodes like this one, look for the Netsmart CareThreads podcast on Apple Podcasts, Google Podcasts, Spotify or Stitcher.

Welcome to net smart care threads, apodcast were human services and post ocute leaders across the healthcarecontinuun come together to discuss industry trends, challenges andopportunities. Listen is we uncover real stories about how to innovate andimprove the quality of care to the communities we serve? Let's get intothe show thanks everybody for joining to. Theyreally look forward to the conversation with Edo. So youknow is the obviouslythe national hospice impoditive Care Organization. It's the the nation'soldest and largest nonprofit leadership organization, working on behalf ofPOSSIBL SOM, how to care providers and professionals priorto joining an HPCAHO.Mr Bannick was a partner in the firm of Galagher Elvis and Jones in BaltimoreMaryland, and he served as a deputy director o Medicare MedicaidCoordination Office at the Center for...

Medicarea Medicaid Services Before hisleadership R, all at CMS. He served as associate general couns to Ising NurseService of New York, Mr Bannic calld, a Ba from Bingamton University and a Jdfrom the University of Pennsylvania Law School. Let's get started with sort ofhow technology plays Ar Oll in the provisioning of care. One of the thingsthat I just love about hostice, andpalitive care and one of the thingsI feln in love with very early on seventeen years ago, when I got startedin the industry, was that it was more than just treating the physicalcondition of the patient and or family member. It's also dealing withpsychological issues. It's dealing with emotional issues. It's dealing withspiritual issues such an incredible service that these individuals providein all caresatngs and so in the human touchworld that were in that is, youknow, high touch with patients and...

...families. How have you seen technologyhelp with the provisioning of care in cost Liss Impootiv Care? Thank you forthat, but the best the best example, obviously, is the use of Tella Healthto do the face to fances interview, for example, used to be a face to faceinterview, and we interviewe pretty early on with Congress to say look.This is something that probably period, but especially during a pandemic can bedone virtually and the same as true of visits themselves, so we have obviouslyseen an increase in the use of telle health. I think the word of cautionthere and I think wer. We want to make sure that we learn from this pandemicand accelerate some of that move. But at the same time, not too far is westill have a very lonely country in some places, a very isolated country,my great Ann Ruby, who just moved into an assistent living. I used to playjeopardy with her Alexa. That didn't mean that she wasn'tlonely. She still was she still needed...

...that he man touch. So we have to makesure that we use technology appropriately, but not to replace thehuman touch, and that is, I think, it's really the sweet spot, tef podspice, anPalliatof tere organization. So when thies, when does a person actually needa human touch, provide that human touch and when, when can they do with avirtual visit, make sure you do that and then importantly make sure thathospices and aliative care programs are compensated for the technology that ittakes to do that. You know there, as you know, they're, not always in factat they're. Nowhere near as compensated a as hospitals and other institutionsare when it comes to technology. So that's something we need to improve.Are you seeing any trends were on the topic of providing hospiice and how tocare in the Longterm Care Community? Are you seeing trends in the tranitionsof care that Youyou've seen so patients coming from the acute care side and andAvey seen technology playing a role there yeah? Well I mean we are, I think,and providers are seeing more...

...individuals go home and I think thatyou know this requires, and I think we get to this later, but differentdifferent flows of referral patterns. I think that increasingly we are going tohave a pracute and want to have sort of a pretty cute strategy that doesn'tnecessarily rely on individuals to decompensate go into the hospital gointo a subbacube and then become eligible for hospice. It would be muchmore effective and you know more humane from from a person perspective, toprovide prehospice, serious olness care in the community and then have thatindividual beeligible for hospice. They need to go to a nursing, Fansilti or a hospital atthen they should, but they shouldn't automatically go there just in order tosort of get on this conveyor belt. That takes you through the end of life.That's not humane! I don't think that's...

...what anybody wants in what ways do yousee the delivery system? You know evolving as we transitioned to oursecond theme year, so taking a look at the health care system as a whole. Whatways do you think the healthcare system evolves moving forward and what doesthat mean for hospice and pitive care providers right? So you knowtraditionally it's been the case that hospice has been a feefer servicebenefit separateand, apart from from everything else and really sefering.Apart from a lot of the changees ionovations havhave been going on for better or worse, I think hospice isgoing to become more integrated into the rest of the of the system andthere's a huge outside, because more people can know about it and canactually be a part of the the overall plan of care and there's a hugedownside. Also because I think the rest of the healthcare system is picked upon the fact that people actually want person centered into display care. Sowe have to make sure that hospins is not supplanted, and you know you seewhat I'm talking about, not just in the...

...future, but actually in what'shappening already there. I is an announced vibid demonstration thatwould carn pospicens a Medicare advantage, which we think is prematureand not ready to go in January of two thousand and twenty one and we've madethat known. There is a a direct contracting demonstration,then really stands for the proposition that the government's going to contractwith different entities, and these could be everyone from a drug store toWalmart, to Amazon, to deliver all medicure services, andso again. Instead of being cut out when separate the hospitals,components going to be included and anything that entity is paid for andessentially carpd in, and that's something that's worth paying attentionto, so it's no longer just nedicare advantage. It's everything thatpotentially could wrap hospice. You know in now the upside isthat this pre hospice population that...

...doesn't have less than six months tolive, but maybe has three years to live. Maybe we're talking about somebody withCPD or demensia. These are individuals who really can benefit from Entrandisciplinering persons, tanter care in the community, and yet we make them gothrough this entire Rigam role for the last three years of their life. Inorder to finally get some semblance of that at the very end. If we can takesome of these some of thes evolution and actually provide some of what weprovide for a couple days or a couple weeks for much longer time, it's goingto bring cost down it's going to Ben Quality up and it's going to bringsatisfaction of t as well mean it's something we're excited about, and thisgoes back to. Basically, the payment systems evolvingof the Medicare advantage carv ends is that the patient is would not possibly be getting thechoice and possibly be stuck with a...

...hospice that maybe doesn't provide thehighest level of care right, and so how would that be checked under these newmodels or medical groups with doctors on staff and the hospice Doctoris, notwanting to contract with other hospice? Now this is going to impact everythingfrom patient choice, to quality of care to the overall hospice model. Amen.Look, I think, in a perfect world and we're not in onehe medicare adbandage plan could actually help address. Some of theissues owe were just talking about if you're in Lla county- and there arefive hundred hospices and a lot of them are not particularly good and the plan only contracts with theones that are good, then, maybe that's that's an advance, that's something wecan talk about. The fact, though, is that's not how this is rolling out andthe concerns that that that Woul, just araticulated of my concerns as well andI'd, go one step further about patient...

...choice. What happens when the ManageCare Organization Ould Contract with one entity for Pallitof care, which wewere just talking about, there's no definition of Palatof Care? So what arethey contracting for whatever they make it up and then a different provider forhospice? What I'm worried about is that Mrs Smith, who' seriously ell is goingto be referred to the Pallin of care provider first and she might never getto the hospice provider, even though she might be elgiible for hospitace.That would be not okay. That would be not legal, but I have some concerns,but that is what's going to happen and we're watching that incredibly closelyand one of the things at we've highlighted for cms: It's not justchoice of hospice, it's also the choice of palion care prehospitice and ifthere's no definition of Pallat of care, how is a consumer to figure out whattheir options are or peal if they don't get their care so ama? If you couldoffer one piece of advice to hospice...

...providers as we weather this covidcrisis? What would that piece of advice, tat? I've got two pieces of advice andI think but but you know I think eadvice should go both ways. I you knowI want to. I want to get advice as well, but I think number one makes true thatfolks in your community are aware of really the high work h, the heroic workthat you and your staff are doing to stay safe and, at the same time, to goin and provide care to me. This is a moment that you know sort of is right up there with the reaction to theHFID and age crisis. You know you had a whole country running away fromsomething and then you are at a community running toward it and sayinghow can we help and I think that letting you know understanding Livin inthe community of that I think, is incredibly helpful. The other thing is breathement support. You know covid'sgoing to be going to be gone at some point. I think it's going to be a longtime before it's gone, but the latent grief and bereavementthat is going to go on throughout our...

...country. It's going to last for a longtime. You know I wasn't there for my father's death, for example, that'ssomething that's going to stay with people and so the extent to which andI'm just using that as an example, my father still alive the you know. Thefact is that if you provide grief and grief and support, you should do moreof it. If you don't, you should do more of it. I think that that is a lot ofwhat the community needs and that's really going to help us advocate Ed,the federal level to say: Look. We need additional to support because look atall these things that were doing that we did do while this nation was reallyhurting, and I think it's a good investment in the future of thismodelef care well, land here fast forward, six to twelve months from now,where do hostice providers need to be most focused on? I think the mostimportant thing is diversification. If there is an opportunity to provide youknow, person center Introdencmaryn care under contract with different kinds ofentities, a hospital calling itsel an...

ACO, a physician group providing aserious illness model, SIP Medicare advantage plan. I think it's going tobe really important for the hospices to establish those relationships toacquire the technology, that's necessary to take risk and really to begin or to continue to live in this sort of new value basedworld, because at some point it's going to be all that's left for better orworse, and I think it's really important that, if you're not in thatspace to get in that space and diversify as much as possible- and Ithink those who do that will be quite successful and we're there to help atTAT. SMART, we understand the challenges facing providerorganizations. Our team will help you navigate changing value, based caremodels with solutions and services that make person centered care or realitywill equip you with technology and services that provide holistic, realtime. Views of Care Histories that...

...inform better decision, Makitg andbetter outcomes visit us today, an ntstcom Netsmart serving you. So youcan serve others thanks for listening to the Netsmart Care, threads podcastthrough collaboration and conversation, we can work together to make healthcaremore connected than ever before and better support the communities we serveto ensure you never miss an episode. Please subscribe to the show in yourfavorite podcast player, if you use apple, podcast, we'd love for you togive us a quick rating for the show. Just have the number of stars that youthink the podcast deserves until next time.

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