Historically, Grand Junction has low Medicare costs. How much does that have to do with HopeWest?
- There is no obvious correlation between the low costs and the impact of HopeWest.
- However, in high cost areas, hospice does lower Medicare costs.
- Grand Junction hospitals tend to have lower mortality rates.
- The HopeWest Care Center does help lower costs. Some folks never go to the hospital, they just come to care center.
- There is a community in Texas, same size as Grand Junction, with several for-profit hospices and their Medicare costs are very high.
Death in Grand Junction is a different experience than it is in the rest of the country. Is HopeWest part of the reason for this difference?
- Grand Junction has a collaborative history and a great climate for providers. These two elements help drive success.
- The HopeWest model could be duplicated. If the core methodology of HopeWest was transplanted somewhere, it would be successful.
How can providers help to make hospice successful?
- Hospice care was around before HopeWest and hasn’t changed much since.
- The average census was 25 patients, now 450.
- Institutions have an absence of vision and an identity crisis. They tack on hospice services.
- It is the difference between being a Strategic Social Change Agent and a Responsive Service Provider.
- A Responsive Service Provider waits for the phone to ring and then responds.
- HopeWest is a Social Change Agent. Everything is geared toward the community.
How was hospice a social movement?
- It used to be an all-volunteer social reform movement.
- Folks sat in living rooms in the 1970s trying to figure out how to make dying a more positive experience.
How do you balance between the social movement and the business of hospice?
- The two concepts are integrated. Hospice can still be a warm and patient-focused service and be a business at the same time (no matter what profit status).
- There seems to be two camps: hospice as business or hospice as social.
- HopeWest strives to be an impeccable member of both camps.
- The complexity of the business of hospice is also important.
- HopeWest has a $40 million budget and business sense is required.
- Most important: you can’t lose focus on the why of the business.
Should there be for-profit hospice?
- It is all in how you do the business.
- The benefits and perils of Wall Street financing is more on the perils side.
- Decisions are made by financers rather than based on organization needs.
- For profit allows you to scale.
- Perhaps the hospice movement wouldn’t have taken off if the forerunners hadn’t scaled.
How is HopeWest a social movement in Grand Junction?
- Death is not a medical event. Death is a social event.
- This is about how we close the last chapter of our life.
- We know that patients and families are complex so that means that hospice staff is watching the kids in the families, assessing how they are handling the situation.
- Checking with the spouse and caregivers.
- All of these things really matter.
- Leverage the collaboration within the community without duplicating resources.
- If we get into the competitive mode of duplicating resources, there’s less to go around.
- Bring awareness to the people who need to know about HopeWest.
- 1400/1500 volunteers are attached to families, they know what HopeWest does.
- Throw a fundraiser with 1500 people, they know what HopeWest does.
- Have materials at the restaurant where everyone eats, all of the customers will know what HopeWest does.
- It de-stigmatizes something that is the scariest thing in our lives. Most people would just as soon not say the word. We’ve done a lot of specific things to de-stigmatize what we do.
Did the notion of Death Panels impact hospice care?
- Only heard about them as a passing phenomenon, never locally.
- The health plans had to think really hard about their support of HopeWest, it could look bad.
- However, when you look at HopeWest’s clients, they are in the last years of their lives.
- If HopeWest were a “brink of death” hospice, it would be harder to gain support.
- HopeWest has changed how the community defines hospice.
- Changing their name to HopeWest helped, people think of them as helping people who are sick, not as a hospice.
- The average length of time in palliative care is 400 days – the last couple of years of life is the target patient population.
Why does it seem that hospice makes care make sense?
- Regular health care delivers care only by means of how it is paid for; it is provider focused, not patient focused, and fragmented.
- Hospitalists make things even more siloed; the primary care providers have less of role in the hospitals.
- This creates a lack of communication, conflicting orders.
- The acute care paradigm is scientific.
- If there is a change with a patient, we want to know why so we run tests, not really thinking about what we are going to do with the information.
- Not as capitalistic as generally assumed, more like a paradigm of treatment that providers get caught up in.
- The system enrolls the patient and family in a trajectory of “doing what you do when you do it” and not looking at the global situation because they can bill for what is done.
- Systems of care and providers are not the ones providing these services, technicians are, and they don’t stop to consider whether the patient needs the services.
- The train starts rolling and just keeps going.
If you could change one thing about existing system, what would it be?
- For-profit institutions and a capitated model don’t go together.
- The for-profit institution with a capitated model is questionable because there is a built-in incentive to refuse care.
- However, non-profit, capitated health care could work.
- With a non-profit model, you get community engagement and financial support rather than a model where everyone gets rich and then the community is asked to take the burden.
- Hospice needs to be an integrated part of the community.
Coming in April:
It is estimated that by 2030, Colorado’s population over the age of 65 will increase by 150 percent. Colorado is known for being an active state, and as the demographics of the population shift, the demand for costly joint replacement procedures is likely to grow.
Across the nation and in Colorado, prices for knee and hip replacements vary widely. According to comedprice.org, out-of-pocket cost for knee replacements in Colorado can be anywhere from $20,000 - $58,000, while hip replacements can be as low as $21,000 and as high as $36,000. The Colorado Public Employees’ Retirement Association (PERA), a self-insured organization, is proactively addressing variation in joint replacement cost and quality through their PERACare Select Program for Hips and Knees.
“PERACare members receive about 100 joint replacements a year,” explains Jessica Linart, PERA’s Insurance Manager, “and PERA’s costs for in-network knee and hip replacements can vary by as much as $80,000 depending on the location and facility.” To minimize this variation and simultaneously improve care, the PERACare Select program is working with facilities that have agreed to provide joint replacements for a pre-determined price.
PERA has partnered with five metro-area HCA/HealthOne facilities to offer the procedures to eligible members with no out-of-pocket cost for most patients. “The providers who are participating in this new option are highly qualified and experienced surgeons. These providers boast lower site infection rates and shorter hospital stays than the national averages,” Linart notes. “This select group of doctors and facilities have set a fixed price for a full suite of services from intake to discharge, including surgery, hardware, anesthesia as well as pain block and management.”
Has PERACare Select been a success? What cost savings have been realized through the program? How has PERACare effected outcomes?
Join us during lunch on Friday, April 28th when CIVHC’s Chief Medical Officer, Jay Want, MD chats with PERA’s Executive Director, Gregory Smith.