Hospices Optimize Admissions Process to Boost Admissions, Length of Stay

Speedy hospice patient admissions can lead to improved referral numbers, profitability and length of stay, recent data show Yet, hospices need to carefully navigate their patient admission processes to maximize their revenue.

Timely initiation of care is an important metric for hospices to measure and monitor, according to recent research from BerryDunn. Referral-to-admission times can impact both their patient volumes and lengths of stay.

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

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

A little more than 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 others, according to Doak.

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

Delays between referral to admission also adversely affect patient satisfaction, according to Doak.

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

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.

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).

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

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

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 day, 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.

Though speedy patient admissions can be beneficial, hospices must walk a fine line between admitting referrals too soon versus too late, according to Mollie Gurian, vice president of home based and HCBS policy at LeadingAge. Leading Age is a national nonprofit aging services provider and was among the study’s sponsors.

“Once an incoming patient and [their] referring physician are comfortable with the decision to move ahead with hospice care, a swift admissions process is important,” Gurian told Hospice News in an email. “However, there are some risks in admitting too soon.”

Hospices must be careful when it comes to balancing admission time and diligently evaluating for patient eligibility, Gurian continued.

Hospices that admit a patient in advance of having the full breadth of their clinical information risk coverage denial if they’re found ineligible for the benefit, she said. This means hospices wouldn’t receive reimbursement for that patient. It could also create a disincentive for that patient to elect hospice when the time is right, she added.

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

“Admitting patients quickly supports excellence in patient, family and referral source satisfaction and feelings of confidence that everything is under control,” Eaves told Hospice News. “This provides peace of mind to the patient and family, and assures the referral source that the patient has been successfully transitioned to their next setting of care. This will enhance the agency’s reputation with referral sources as a reliable resource and can be a competitive advantage for the agency to promote.”

Hospices can also lose prospective patients because of inefficient admission processes or slow responses to referrals, according to Adrian Schauer, CEO and cofounder of home health software provider AlayaCare.

Bearing all of this in mind, many hospices remain short-staffed.

Staffing shortages proliferating the hospice industry for several years running have taken a toll on patient admission processes and the ability to connect with referrals.

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

Roughly 59% of hospices from the BerryDunn study indicated that they’ve had to turn away referrals due to the staffing shortages, Doak stated.

With limited staffing resources, hospices have increasingly sought ways to create admission efficiencies. Focusing on earlier admissions and length of stay is one key to the puzzle, according to Schauer.

“In order to increase efficiency and spread out staffing resources, agencies can adapt their admission process to focus on earlier admissions with longer stays,” said Schauer. “The initial steps in patient intake are vital for all hospice agencies, ensuring that they have a clear and smooth admission process to help set the entire patient’s experience up for success.”

Routine meetings between business development and hospice operations staff that focus on process improvement can “go a long way” toward creating an environment that maximizes performance, according to Eaves.

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

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

“Processes that can optimize hospice admissions include utilization of community partners for referrals, maintaining an efficient intake department and keeping caseloads manageable,” Gupta told Hospice News. “[This] increases efficiency by allowing for timely documentation, and a consistent focus on training and relevant competencies. Staff education and leadership commitment are also important to continuous [admission] process improvement.”