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Vlada Karpovich

Data


HOSPICE CASE MANAGER WORKLOADS CORRELATE WITH LONGER STAYS, PROFITABILITY

By Jim Parker | September 23, 2022September 26, 2022

Vlada Karpovich


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Careful management of hospice care manager workloads correlates with longer
lengths of stay and improved margins.

Length of stay is an important metric from both a clinical and business
standpoint. For many patients length of stay is a week or less, which is too
short for them to receive the full benefit of hospice care.

From a business perspective, patient populations who experienced longer lengths
of stay boosted hospice margins by as much as 20% during 2016, according to a
report from the Medicare Payment Advisory Commission (MedPAC).

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Recent research from BerryDunn has found that limiting case manager workloads
can positively impact length of stay.

“No matter what data point I looked at, I went back to that caseload and every
single time if you got past 25, both your patient satisfaction and your quality
outcomes are diminished,” Lindsey Doak, home health and hospice leader for
BerryDunn, told Hospice News. “The smaller the caseload, the more you have
control of your patients. But also, if you have a caseload of 25, you are able
to see your patients at least once a week. Whereas once that increases, you can
no longer maintain that. You’re sending out another clinician.”

Historically, caseloads for hospice nurse case managers have hovered around 10
to 12 patients, but these numbers have been trending upwards.

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Among the hospices that BerryDunn surveyed, 88% of the best performers kept case
managers’ workloads between 13 to 18.

BerryDunn polled more than 1,000 hospice and home health agencies in its
National Healthcare at Home Best Practices and Future Insights Study. Of those,
249 were hospice agencies that ranked in the top 15% on Consumer Assessment of
Healthcare Provers & Systems (CAHPS) scores. The survey questions focused on
operational, clinical, and financial best practices.

The No. 1 complaint that families report on hospice CAHPS surveys is that they
wish their loved one had entered hospice sooner, according to the U.S. Centers
for Medicare & Medicaid Services (CMS).

Patient admission times and lengths of stay also have implications for hospices’
revenue streams. BerryDunn researchers found a direct correlation between length
of stay and a hospice’s likelihood of profitability.

Among hospices with an average length of patient stay between 41 and 60 days,
around 82% yielded higher daily revenue. Those whose average stay was 40 days or
less achieved a 29% positive profit ratio, while those with 81 days or more had
0% or negative profit ratios, according to BerryDunn.

“If you look at the caseloads, organizations that have that 19 or less or 20 to
25 have increased profitability standards, with the key metric being five to
five-and-a-half visits that they’re adding,” Doak said. “You have fewer
patients, but now you’re better able to manage them, and then you’re able to
increase your productivity because you have a caseload that’s more manageable.
That is then having a relationship, because we know that productivity relates to
your profit surplus margin.”

But reducing workloads can be a challenging proposition in an industry in which
labor shortages are the biggest headwind. These staffing woes have long plagued
the hospice industry, but have only worsened since COVID-19 hit the United
States in 2020.

Roughly 18% of health care workers have left their jobs during the pandemic,
while 31% have considered leaving the field altogether, according to a
nationwide 2021 Morning Consult survey. Burnout, poor wages and the pandemic
itself were leading reasons.

Despite rising demand for care, these pressures have caused a number of hospices
in the United States to shut down, sell their businesses or downsize. The
corresponding reductions in clinical capacity have also led to record numbers of
declined hospice referrals.

One strategy that some hospices have adopted is to involve more social workers
in case management while trying to stay in that 13-25 patient range.

“Most organizations would tell us that an increase in the utilization of social
work, so incorporating social work into the patient’s care is increasing their
the quality of their life at the end of life, and then also increasing their
median length of stay,” Doak told Hospice News. “So we’re seeing them live
longer, a matter of days, which in hospice is fairly significant.”


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COMPANIES FEATURED IN THIS ARTICLE:

BerryDunn


JIM PARKER

Jim Parker is a subculture of one. Swashbuckling feats of high adventure bring a
joyful tear to his salty eye. A Chicago-based journalist who has covered health
care and public policy since 2000, his personal interests include fire
performance, the culinary arts, literature, and general geekery.

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