Hospices Optimize Admissions Process to Increase Admissions and Length of Stay


According to recent data, rapid patient admissions to hospices can lead to improved referrals, cost-effectiveness and length of stay. Still, hospices must carefully navigate their patient intake processes to maximize revenue.

Timely initiation of care is an important metric for hospices to measure and monitor, according to recent to research by Berry Dunn. Delays in referral to admission can have an impact on both the number of patients and the length of their stay.

“What we have seen from [the study] is that the most successful hospices massively admit their patients within four hours,” Lindsay Doak, national director of research at BerryDunn, told Hospice News in an email. Doak also served as co-chair of the study.

BerryDunn surveyed more than 1,000 hospice and home health care agencies as part of its nationwide study of best practices and future prospects for home health care. Based on Consumer Assessment of Healthcare Providers & Systems (CAHPS) scores, hospices ranked in the top 15% were surveyed on operational, clinical, and financial best practices.

Just over three-quarters (76%) of hospices surveyed admitted patients within four hours. These hospices also had the highest median length of stay of 32.5 days, nearly 10 days longer than the others, according to Doak.

Hospices should aim for an average of eight hours or less from referral to admission, according to the BerryDunn researchers.

Delays between referral and admission also have a negative effect on patient satisfaction, according to Doak.

“Once agencies get beyond 24 hours from referral to admission, they see a significant drop in family satisfaction and length of stay,” Doak said.

For many patients, the length of stay is a week or less, which is too short for them to fully benefit from palliative care.

According to the US Centers for Medicare & Medicaid Services (CMS), the #1 complaint families report in CAHPS palliative care surveys is that they wish their loved one had entered hospice sooner.

Recognizing this, more hospices have diversified their services to move care further upstream and reach patients earlier.

“As we see more and more agencies providing services across the continuum of care, we are also seeing an increase in the number of patients being admitted to hospice — and more importantly — in a timely manner,” Doak told Hospice News.

Patient admission times and lengths of stay also affect hospices’ sources of income.

BerryDunn researchers found a direct correlation between length of stay and the likelihood of a hospice being profitable.

Among hospices with an average patient length of stay between 41 and 60 days, about 82% generated higher daily revenues. Those whose average stay was 40 days or less had a positive profit rate of 29%, while those whose stay was 81 days or more had a profit rate of 0% or negative.

According to Mollie Gurian, vice president of home policy and HCBS at LeadingAge, while admitting patients early can be beneficial, hospices need to distinguish between admitting referrals too early and too late. Leading Age is a national non-profit aging service provider and was among the sponsors of the study.

“Once a patient arrives and [their] treating physician are comfortable with the decision to move forward with palliative care, a speedy admissions process is important,” Gurian told Hospice News in an email. “However, there are risks in admitting too soon.”

Hospices must be careful about balancing admission time and diligently assessing patient eligibility, Gurian continued.

Hospices that admit a patient before they have the full extent of their clinical information risk being denied coverage if they are deemed ineligible for the benefit, she said. This means that hospices would not receive reimbursement for this patient. It could also deter that patient from choosing hospice at the appropriate time, she added.

Faster admissions can also fuel strong referral relationships, said Andrew Eaves, home health and palliative care consultant for BerryDunn. Admitting patients in a timely manner promotes referral satisfaction and increases their confidence in a palliative care provider, giving them a competitive advantage, Eaves said.

“Rapid patient admission supports excellence in satisfying patients, families and referral sources and feeling confident that everything is under control,” Eaves told Hospice News. “This provides peace of mind for the patient and family and assures the referral source that the patient has been successfully transferred to their next care facility. This will enhance the agency’s reputation with referral sources as a trusted resource and can be a competitive advantage for the agency to promote. »

Hospices can also lose potential patients due to inefficient admissions processes or slow responses to referrals, according to Adrian Schauer, CEO and co-founder of home health software provider AlayaCare.

Given all of this, many hospices remain short-staffed.

The staffing shortages that have proliferated in the palliative care industry for several years in a row have adversely affected patient intake processes and the ability to connect to referrals.

“Many hospice agencies have had to turn down referrals due to employee capacity constraints,” Schauer told Hospice News in an email.

About 59% of hospices in the BerryDunn study said they had to turn down referrals due to lack of staff, Doak said.

With limited staff resources, hospices have increasingly looked for ways to create admissions efficiencies. Focusing on early admissions and length of stay is one key to the puzzle, according to Schauer.

“To increase efficiency and allocate staff resources, agencies can adapt their admissions process to focus on earlier admissions with longer stays,” Schauer said. “The early stages of patient onboarding are essential for all palliative care agencies, ensuring they have a clear and smooth intake process to help prepare the entire patient experience towards the hit.”

According to Eaves, routine meetings between business development and palliative care operations staff that focus on process improvement can “go a long way” to creating an environment that maximizes performance.

Proactive strategies and clearly defined workflows can help hospices ensure consistency in their admission times, according to Dr. Aparna Gupta, vice president of quality at the National Hospice and Palliative Care Organization.

Staff roles in patient admissions need to be clearly defined to ensure all elements of the process are in place, according to Gupta. Hospices should also conduct a careful gap analysis of admissions data to identify which strategies are working and which need to be changed, she continued.

“Processes that can optimize hospice admissions include using community partners for referrals, maintaining an efficient admissions service, and managing workload,” Gupta told Hospice News. “[This] increases efficiency by enabling timely documentation and consistent focus on relevant training and skills. Staff training and management commitment are also important to [admission] process improvement.”


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