Hospice care has grown so rapidly in recent years, climbing from 870,000 Medicare patients nationally in 2005 to 1.27 million in 2012, that it has reshaped the healthcare industry in New Jersey.
One area where this change can be seen most dramatically is in home care. Hospice — care at the end of life focused on relieving suffering — was once delivered in a separate facility. But since Medicare began providing a hospice benefit in 1983, most of the care has been provided in people’s homes.
The growth in the use of hospice, combined with its shift to the home, recently led an industry trade association to incorporate the word “hospice” into its name for the first time — the Home Care and Hospice Association of New Jersey.
In addition, providing hospice care at home is a key ingredient to a major move by Barnabas Health earlier this year, when it announced a proposed partnership with VNA Health Group, the Red Bank-based organization that grew out of the Visiting Nurse Association of Central Jersey.
These two changes are signs of the rising demand by patients for home-based hospice care, and of the recognition by the healthcare industry that this area will almost certainly continue to grow. That in turn has led industry advocates to increase their lobbying for home hospice care to be considered by legislators as they draft bills affecting patients and providers.
The Home Care and Hospice Association’s President and CEO Chrissy Buteas said the growth of hospice is particularly important in New Jersey, where patients have led the country in the number of specialists used for treatment and the number of days patients spend in intensive care at the end of their lives. If they choose hospice as an alternative, this could lower costs significantly.
“Our membership has been really focused on, how do we make sure folks are able to make the decisions that that they want to towards the end of their life,” to improve the quality of their remaining time, Buteas said.
The association lobbied legislators to include hospice care in two bills. The first, A-3911/S-2931, requires hospitals and nursing homes to inform patients with serious illnesses about appropriate hospice services. The second does much the same thing with services from the related field of palliative care. Both hospice and palliative care are focused on relieving patients’ symptoms, like pain and stress, rather than curing the underlying diseases.
Buteas noted that the more patients know about hospice, the more they seek it.
“It’s that discussion that needs to take place; we need to have people educated about” hospice, she said.
The Assembly recently passed the bill 74-1 and it’s been referred to the Senate Health, Human Services, and Senior Citizens Committee.
In addition, the association hired its first staff member devoted solely to hospice. Kendra Duran will serve as the director of hospice and clinical regulatory services. A nurse, Duran has guided hospice programs through the regulatory process.
The changes are occurring against a swiftly shifting national landscape. Bill Dombi, an attorney for the National Association for Home Care and Hospice, noted that federal officials and members of Congress are pushing for Medicare hospice payments to move toward “value-based purchasing,” in which providers will be rewarded and penalized for how they perform according to quality measurements.
“It is not an easy concept: What are the right outcomes? What are the right measures? How do you reward and how do you penalize providers of services?” Dombi said at the state association’s recent annual conference in Atlantic City.
The Barnabas Health-VNA Health Group partnership would expand the state’s largest hospital system’s ability to provide home-based hospice and other homecare. It was announced in May and is undergoing state regulatory review.
Barnabas executives have been increasingly focused on the subject of homecare and hospice, as part of their broader goal of managing the health of populations of patients throughout the entire healthcare system. Barnabas united its separate businesses in hospice and home health in Essex and Ocean Counties a year and a half ago. Now it has the potential to add VNA’s services in Monmouth, Middlesex, Hudson, and Burlington Counties. VNA Health Group also serves Essex.
This geography aligns with the even larger merger that Barnabas announced last week, with RWJ Health System, which has hospitals in Middlesex and Burlington Counties, as well as in Somerset and Union Counties.
Barnabas Health Home Care and Hospice chief executive Keith L. Boroch said he’s seen hospice grow in importance to home-health agencies since he first worked in New Jersey as the chief financial officer of VNA of Mercer County in 2000.
“We have an aging population, people with multiple chronic care needs, and (are) in a situation where there was a strain on resources for dollars, so it has really elevated community-based care, wherever that is,” Boroch said.
From a hospital-system perspective, the importance of hospice is part of a broader emphasis on providing care in a community setting. This effort is most prominent in areas like treating chronic conditions like diabetes so that they don’t lead to unnecessary hospitalizations.
“We have to be honest enough in talking with our patients about the consequences of treatment and what their options are,” Boroch said, adding that the demand for hospice has been driven by patients’ own wishes.
VNA Health Group Chief External Affairs Officer Sherl Brand, who preceded Buteas as the head of the trade association, said the growth of hospice has shifted New Jersey’s health system away from its tradition of “treating, treating, treating, instead of quality at the end of life.”
“Palliative care can serve as a bridge between the traditional, curative delivery of care to addressing more the symptoms and the pain. And then, when that individual is ready to say, ‘Yes, I’m ready for hospice care,’ it can easily then transition into hospice care,” Brand said.
Brand helped lead this change at the association, including the word “hospice” in its mission statement several years prior to the name change.