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Palliative care can lower cost and bridge transitions and conversations
Editor’s note: This article was written by guest blogger Anthony Cirillo, FACHE, ABC, a healthcare marketing and experience management expert and expert guide in assisted living for about.com. For more information about the author, please see our About page.
We hear so much about lowering costs in healthcare today. And yet:
- 93% of physicians practice defensive medicine, ordering diagnostic tests, referring to other specialists, and prescribing medications
- 28% of Medicare spending occurs in the final year of life; 12% occurs during the final two months
- 38 states have obesity rates over 25%; 42 states have diabetes rates over 7%; one in five adults smoke cigarettes adding $100 billion of healthcare cost
We can argue malpractice reform, personal responsibility, and all of that. But we also have to learn to use what we have. And perhaps palliative care can help.
According to presenters at the Governance Institute, implementing a first-class palliative care program can cut costs and provide better quality of life not just for the dying but also those with chronic conditions and serious illness. Using palliative care saves the healthcare system $1,700 per discharged patient.
Waste in medical services is currently estimated at 20% to 35% of total healthcare spending. The following contribute to waste:
- Services necessitated by incorrect and/or unsafe practices
- The use of unproductive or counterproductive interventions
- Failure to use the least-expensive appropriate resources
- Redundant reimbursement
The argument was made that we must have a worldview of palliative care as comprehensive, interdisciplinary care focusing on promoting quality of life. In fact palliative care is the best way to have important conversations with patients and families about the right level of care given the expected outcome.
Of course we are reimbursed in a fee-for-service environment and until the shift to wellness and bundled payments takes place, there is little incentive for providers to change their ways. Yet perhaps if we realize that this could be in the best interests of the patient and truly embrace person-centered care, providers would change.
I think patients know what is right for them and I think families intervene. That is why programs such as Engage With Grace: The One Slide Project are important. It poses five questions designed to help get us talking with each other and with our loved ones about our preferences.
Most people do not die according to their wishes. And they should. That is why they need to put it in writing. And that is where another resource, Five Wishes, comes in.
It lets your family and doctors know:
Who you want to make healthcare decisions for you when you can’t make them
The kind of medical treatment you want or don’t want
How comfortable you want to be
How you want people to treat you
What you want your loved ones to know
Five Wishes has become America’s most popular living will because it is written in everyday language and helps start and structure important conversations about care in times of serious illness.
If we truly put people at the center of care we will embrace alternative care methods such as palliative care and start discussing death and dying in this culture and not avoid it. It is ultimately about quality of life at the end of life.
And providers play a role.
Recognize your part in the big picture
Editor’s note: This article was written by guest blogger Anthony Cirillo, FACHE, ABC, a healthcare marketing and experience management expert and expert guide in assisted living for about.com. For more information about the author, please see our About page.
I am an avid reader of Success Magazine and particularly like one monthly columnist, Mel Robbins. In August she had a column entitled, “Get Over Yourself.” It chronicled her conversation with a New York City taxi driver, a successful owner of a taxi company. Trying to talk about topical things of the day, she brought up former Congressman Anthony Weiner. The cab driver had no idea what she was talking about.
And then Mel had a revelation. This from her article:
“When you are in the middle of a breakdown in your life or business, you think everyone on the planet knows and that shame keeps you beaten down. Here’s a 26-year-old born and raised in New York, and he’s never heard of Wiener. In that moment, I understood why comebacks are possible. They are possible because most people don’t know or care what you’ve done.” She further states: “We are all so worried about what everyone thinks that we limit what’s possible. We also convince ourselves that everyone knows. It’s called ‘imaginary audience syndrome.’ ”
Henry Ford has a related quote: “The competitor to be feared is one who never bothers about you at all, but goes on making his own business better all the time.”
That is good stuff. Sometimes we take ourselves too seriously. And while the long-term care industry is serious business, we often forget the context of where we fit in people’s lives.
We are selling something they don’t want.
It could be years before they need it.
They are struggling with other no less important issues in their lives.
So while we may be shouting from the roof tops how great we are and all that we offer, it often falls on deaf ears.
Want to connect with those people?
Intersect their priorities at this point in time.
Families are struggling to make ends meet, so invite coupon-clipping experts to present a seminar on how to save money. It could be fun. It would be an adventure in learning. And families will remember who sponsored it. This is just one example. You can think of better, but you get the idea.
Caregivers are often suffering from worse health than the loved one they are caring for, so pamper them. Have a caregiver appreciation day. Offer free spa services to them while you care for the loved one that day too.
Baby boomers are struggling with taking care of mom and dad while trying to figure out how to retire, so invite financial experts to present an educational program. Help them figure it out. It benefits you in the end.
What you have is sometimes what people don’t want or need at this time. But they have other needs. Intersect them.
Don’t limit what’s possible. Think outside the healthcare silos we have created. Think about the larger slice of life context. Realize you are an important part of it, but you are not the greatest thing since sliced bread.
Thriving Mentality Begins With One Individual at a Time
Editor’s note: This article was written by guest blogger Anthony Cirillo, FACHE, ABC, a healthcare marketing and experience management expert and expert guide in assisted living for about.com. For more information about the author, please see our About page.
We seemed to hit a nerve with last month’s blog about optimism and understanding that individuals have brand identities. Dozens requested our brand attribute test.
Here is one reader’s comment:
“I have been hearing several leaders in our industry saying ‘If we are to survive’ or ‘In order for us to survive,’ statements that are negative in nature. I did not realize how much those statements were bringing me to a near point of despair. At any rate, I came across your blog on MDSCentral, Thriving – Not Surviving – in Today’s Healthcare Environment, and was inspired to push through the ‘this is what it is’ and get to the ‘what can I do to make this better for my facilities.’ ”
I absolutely love the sentiment “what can I do to make this better with what I have.” We need more of that thinking because it leads to innovation.
In my workshop, You the Brand, I talk about how people can position themselves to stand out from the crowd. Each of us has the ability for innovation. Of course that sometimes means being able to work in an environment that encourages it. And if you are in one that doesn’t, well that should tell you something too. But let’s look at some positioning strategies you can pursue that in turn lead to innovation.
Be the first
Just as Julia Child was the first celebrity chef and Michael Dell was the first to sell PCs direct over the internet, what can you be the first in? Again, ask yourself, what do people want that they don’t have now? What do they complain about that needs a solution? What needs are not being met in the industry, in your facility, in your community?
Be the leader
If I came into your company and asked who the expert was in a particular skill or area, for what skill would they point to you? List those areas and next to them, list how you can go from good to outstanding, thereby making you the leader.
Be the revolutionary!
I have built my consulting business by taking the exact opposite position of my colleagues when it comes to my philosophy on patient/resident experience and strategic marketing. That has helped me carve a niche among people who obviously agree with me. Now this can be dangerous territory so tread carefully. You have strong opinions on issues. How do yours differ from industry norms and how would you solve problems differently? List areas where you clash with the accepted but are passionate about your views and passionate in your belief that there is a better way.
There is no shortage of problems in the industry. Step up and solve them. Each of us has the power to innovate.
More Medicare Myths
The following Medicare Myths were taken from the HCPro book, Long-Term Care Skilled Services: Applying Medicare’s Rules to Clinical Practice. For more information about this book, or to order, please visit the HCPro Marketplace.
Note: For myths 1-3, please see previous post.
Myth #4: All residents who are receiving tube feeding are always skilled and always will be skilled.
This statement is both true and false. The caveat lies with the level of calories and fluid the resident is taking in through the tube. As we discussed in Chapter 4, residents who meet the 26%–50% of calories AND 501 cc of fluid per day via the feeding tube OR residents who receive 51% or more of calories via the feeding tube will automatically qualify for Medicare Part A benefits in a SNF. Additionally, they are required to continue on Medicare to use a full 100-day benefit period until they drop below such levels on an MDS. These levels will also continue that spell of illness and prevent the resident from attaining the 60-day period of wellness, to qualify for a new 100-day benefit period.
Residents who meet the caloric and fluid requirements of 26%–50% of caloric intake and 501 cc of fluid daily via the tube OR residents who receive 51% of more of caloric intake from the tube will remain at a skilled level of care for a full 100 days, as long as they remain at those levels. In addition, the resident will not qualify for a new 100-day benefit period unless he or she:
- Drops below the calorie and fluid levels previously identified for 60 consecutive days without any other skilled service in the SNF or inpatient hospital stay
- Remains at those calorie and fluid levels identified previously but discharges to home with skilled services being provided in the home for 60 consecutive days
Myth #5: As long as there is an inpatient hospital stay or Medicare Part A SNF stay within the last 30 days, we can pick the resident back up on Medicare Part A.
Although this is partly true, the most important criteria to using the 30-day window as discussed in Chapter 2 is relating the reason for coverage back to the original hospitalization or a condition that arose during treatment. If the reason to pick the resident back up under Medicare Part A is completely unrelated to the original hospitalization or subsequent SNF stay, the criteria outlined in the regulation regarding the 30-day transfer rules are not met, and the resident should not be put back on Medicare Part A.
Myth #6: A resident on Medicare Part A in a SNF can never leave the SNF for an overnight leave of absence.
Often, a resident is unable to leave the SNF due to the complexity of the services being rendered in the SNF. That said, a couple of items need to be reviewed before determining if an overnight leave of absence (LOA) is feasible.
- Can the resident safely be away from the SNF and can the family or responsible party be taught to safely meet the resident’s needs while out of the SNF?
- Are the absences infrequent in nature and not for prolonged periods of time?
Obviously, question one is important to make sure that the resident can be properly cared for during the LOA. It is always necessary to consult with the resident’s physician to notify him or her of the LOA request and get some feedback from the physician’s point of view on whether the LOA is feasible. The second question relates more to being sure that the practical matter criteria also discussed in Chapter 3 is being met. If a resident is able to leave the SNF on a weekly basis for an overnight visit, or if the resident leaves for prolonged periods of time three times per week to attend an off-site bingo game, for example, it is doubtful that the practical matter criteria is being met. Remember, one of the four criteria related to meeting the skilled services requirement in a SNF is the practical matter criteria identified in Section 30.7 of the Medicare Benefit Policy Manual (Pub. 100-02):
- As a practical matter, considering economy and efficiency, the daily skilled services can be provided only on an inpatient basis in a SNF (see §30.7).
That said, although a resident may safely be able to go on LOAs frequently or for prolonged periods of time, the question becomes: Is the SNF the most appropriate place for that resident to receive those skilled services?
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Satisfied Customers Seldom Sue
Take action and boost your facility’s reputation in the community with Satisfied Customers Seldom Sue: A Guide to Exceptional Customer Service in Long-Term Care, a new HCPro book and CD-ROM designed to cultivate strong customer service skills in your long-term care nurses, frontline staff, and any other staff member who interacts with residents and families.
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Avoid common mistakes that compromise compliance and payment
Take the mystery out of skilled services and know when to skill a resident based on government regulations, Medicare updates, the MDS 3.0, and proven strategies. Long-Term Care Skilled Services: Applying Medicare’s Rules to Clinical Practice illustrates the role played by nurses, therapists, and MDS coordinators in the application and documentation of resident care. Don’t miss out on the benefits and reimbursement you deserve, as author Elizabeth Malzahn delivers clear, easy-to-understand examples and explanations of the right way to manage the skilled services process.
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