As a medical community and as a society, we are more comfortable talking about curative treatment than we are talking about end-of-life care. Which is why health care leaders need to proactively encourage more education and conversation within their organizations about hospice care, because the specialty’s innerworkings and benefits are not well understood.
Hospice is a valuable yet drastically underutilized resource—the median length of service is only 18 days. Yet earlier access to hospice care supports the health care Triple Aim by cost-effectively improving quality of care and patient experiences near the end of life.
How does hospice care make a difference?
Access to care
For individuals with a life expectancy of six months or less—who have discontinued treatment for their life-limiting illness—hospice offers unparalleled clinical, emotional, and spiritual care with family education and support services. Patients can take advantage of as many or as few services as they want, and because the hospice benefit is fully covered by Medicare, Medicaid, and most insurance plans, most patients pay nothing out of pocket. Designed to complement and continue any palliative care already being provided under the Medicare Part B ambulatory outpatient benefit, the hospice Part A benefit can overlap for a seamless care transition.
Improved patient experience
Hospice provides a peaceful and stable care experience near the end of life that allows patients and their loved ones to make the most of their time together. On average, patients receiving hospice care live 29 days longer than those without. And with unlimited benefit periods certified by a doctor, an eligible patient is assured of lifelong care (and for their loved ones, up to 13 additional months of grief support).
By providing one-on-one medical care at home (most often in a private residence, but also in nursing or congregate living facilities), hospice helps to prevent complications, unwanted interventions, and unnecessary hospitalizations. Home is where most patients want to be, and the population outcomes bear this out: hospice care has been associated with higher satisfaction and quality of life, better pain and symptom management, and reduced physical and emotional distress. In fact, most patients report their pain to be managed within 48 hours of start of care.
Why is earlier hospice better?
Hospice is a uniquely compassionate philosophy of interdisciplinary care, centered on the holistic needs and goals of the patient. As such, it is meant to achieve its full benefit over time. Designed to support patients and families through the end-of-life process, hospice provides palliative care and can help with caregiver respite and support, prescriptions and medical equipment, end-of-life planning, social work, spiritual counseling, relationship issues, companionship, therapeutic care, wish fulfillment, funeral/memorial arrangements, bereavement support, and much more.
Patient and family education is always an important piece, so everyone can understand what to expect and how to intervene (or not). An earlier start allows the hospice care team to fully assess and address their client’s final wishes and give them the independence and dignity to set their own care goals and keep living on their own terms. Compared with those who never receive hospice, more families report that their loved one’s end-of-life wishes were met and rate the quality of end-of-life care as excellent.
By minimizing the frequent disruptions that typically occur in the last year of life—tests, procedures, ER visits, hospitalizations, and other transitions in care setting—longer lengths of service in hospice help to significantly reduce health care spending overall. An independent study of claims data by NORC at the University of Chicago estimated that in 2019, hospice care saved $3.5 billion in Medicare spending. For patients who received at least six months of hospice care during the last year of their lives, spending was 11 percent lower than beneficiaries who did not use hospice—across all disease groups, even neurodegenerative conditions.
Leaders can drive these results
Armed with accurate information, health care leaders now have an opportunity to create better access to hospice expertise and care for the benefit of their patient populations. At a fundamental level, this will require training and education for health care professionals and providers to better understand when a transition to hospice care is needed. Physicians can benefit greatly from learning and practicing how to incorporate end-of-life goals of care into their care planning conversations with patients living with chronic disease. And on the policy front, HCOs are coming together to improve access by creating care plan crosswalks between palliative care and hospice care, and by advocating to expand hospice eligibility criteria under the Medicare benefit.
Mike Johnson is President of both the Home Health and Hospice Practices at BAYADA Home Health Care, a $1.7 billion global industry leader with a clear strategic vision of home as the stable center of the health care continuum. Founded in Philadelphia, PA in 1975, BAYADA provides nursing, rehabilitative, therapeutic, hospice, and assistive care services to children, adults, and seniors in the comfort of their homes. With hundreds of office locations throughout the U.S., as well as Germany, India, Ireland, New Zealand, and South Korea, BAYADA is a leading nonprofit home health care provider and the only national provider to offer a full range of home-based specialty care services.
For the first time in home health care, BAYADA completed its transition from a privately held business to a nonprofit organization on January 1, 2019—a decision by its Founder and Chairman Mark Baiada to help ensure that the company would never be sold, and that its mission, vision, beliefs, and core values of compassion, excellence, and reliability—codified in The BAYADA Way—will endure for generations to come. Families and individuals coping with significant illness or disability need help and support, and it is BAYADA’s mission to help people have a safe home life with comfort, independence, and dignity.
Dr. Johnson believes in building a trust-based “team of teams” culture to drive growth, empowering people to make better, faster clinical and business decisions. His professional goal is to help facilitate the redesign of the U.S. health care system to promote universal access to high quality care provided by multidisciplinary teams of professionals in a manner that is cost-effective and patient centered.
Dr. Johnson joined BAYADA in 2009 as Chief Clinical Officer for the home health practice, then became Mid-Atlantic Regional Director of Operations in 2012, and since 2015, now leads BAYADA’s Home Health Practice, focused primarily on post-acute geriatric care services under the Medicare Program. In his tenure, Dr. Johnson has led an evolutionary redesign of scalable processes and infrastructure, building a strong foundation for innovation, clinical and operational excellence, and long-term population health outcomes.
By inspiring and empowering results across five pillars of performance—People, Service, Quality, Growth, and Finance—Dr. Johnson has led his practice to double operating surplus, yield double-digit annual growth, and become the largest nonprofit home health provider in the US. His new collaborative care model is helping to decrease variation in care, reduce unnecessary care visits, and achieve excellent ratings for quality and patient satisfaction. Also, in partnership with a provider-led Accountable Care Organization (ACO), Dr. Johnson designed a new level of post-acute care called “Directly Home” that has saved $1.3M+ in health care costs, reduced hospital readmission rates, and improved patient satisfaction in its first two years. More recently, he took on the leadership role for the Hospice practice in 2021.
A licensed clinician, Dr. Johnson has served the American Physical Therapy Association (APTA) over 20 years in multiple roles, currently on the Scientific Advisory Panel (SAP) for the Center on Health Services Training and Research (CoHSTAR). He is on the Research Committee for the Alliance for Home Health Quality and Innovation and has also served as a member of the National Advisory Council for the Agency for Healthcare Research and Quality (AHRQ), as a Steering Group member for the AQA Alliance (formerly Ambulatory Care Quality Alliance), and as a consultant on the development and testing of quality measurements for use in the Physician Quality Reporting System (PQRS).
Before joining BAYADA, Dr. Johnson directed professional development at Mercy Rehab Associates, Mercy Catholic Medical Center, where he helped create their Circle of Care Program to promote community health, care coordination, and fitness / wellness for the un/underinsured. As part of an earlier academic and research career, including on the faculty of both the University of the Sciences and Drexel University in Philadelphia, Dr. Johnson has been a changemaker in how clinicians are trained and teamed to meet the needs of individuals, care systems, and long-term population health management.
Dr. Johnson holds a PhD in Health Policy from the University of the Sciences, an MS in Orthopedic Physical Therapy from MCP Hahnemann University, and a BS in Physical Therapy from Northeastern University. He lives in the Philadelphia suburbs with wife Beth and near their three adult children, Lisa, Madeline, and Paige. When not working, he enjoys running, hiking, cycling, playing the guitar, spending time with family and traveling throughout the U.S. as well as abroad.