Hospice, Palliative Care Leaders Foresee a ‘New Normal’ for 2023

Hospice News spoke with a group of industry leaders — from publicly traded companies, private firms and nonprofit organizations — about the major trends and most pressing concerns on their radar as the new year approaches.

Common threads among their remarks show that leaders in the hospice community continue to have their eyes on pervasive workforce challenges, potentially disruptive payment models and an evolving regulatory landscape.

Some also see the health care system, including hospices and palliative care providers, starting to settle into a “new normal” after the sea changes that have occurred during the past three years. Nevertheless, leaders say, providers should not become complacent when it comes to COVID and continue to strategize for unexpected events.

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“I think the industry will really be able to put the disruption of the pandemic behind us — I’ve referred to it as removing COVID goggles — and get back to really providing care and operating with a true new normal. That new normal will have much more consistent and predictable guidelines in a health care environment that doesn’t have significant dislocation of patient flow, referral patterns, patient needs, etc.”

— Nick Westfall, CEO, VITAS Healthcare, a subsidiary of Chemed (NYSE: CHEM)

“Both hospice providers and regulatory agencies are expected to continue efforts toward establishing a new normal, post-pandemic; 2023 could also bring operational impacts associated with the likely lifting of some of the waivers that have been in place during the public health emergency. Overall, we do expect some return to normalcy as it relates to routine health care engagement within the senior population.”

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— Stephen Phenneger, president and CFO of St. Croix Hospice, a portfolio company of H.I.G. Capital

“In 2023, I believe we’ll see a recovery in staffing and volumes. I also think we’ll see a continued focus on adhering to the ever-increasing regulations, as well as expectations surrounding quality of care.”

— Barbara Jacobsmeyer, CEO, Enhabit Inc., (NYSE: EHAB)

“The Hospice Care Index, the new measures that are out there, I think that they are an opportunity for us to really look at our outcomes, sharpen all of our processes and be very cognizant of those things that lead into the index, including a good patient care experience. Hospice is now on the same playing field as other types of health care, in terms of being rated by consumers.”

— Susan Ponder- Stansel, CEO, Alivia Care, a nonprofit

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Changing payment models

“I’m most worried about the [value-based insurance design (VBID) demonstration]. From where I sit and the things that I read, the colleagues I speak to who are actively participating with health plans in the VBID demonstration, it’s going badly for hospices. I don’t get the same sense that [the Center for Medicare & Medicaid Innovation] is really listening to how badly it’s going.”

— Lynne Sexten, CEO, Agrace Hospice, a nonprofit

“One of the things that we’re really seeing is that as more of the value-based care is happening. Many patients are being cared for in what we call a substitute competition model, where hospice is not really a good thing in the eyes of those that are at risk for the total cost of care. That’s something I’m looking at very carefully: Is utilization going to continue to slip just a little?”

— Ponder- Stansel, Alivia Care

“The hospice space can also expect to experience continued payer involvement and interest, as well as new and existing trends in the evolving regulatory environment. Merger and acquisition activity will also continue through 2023, especially as hospice providers work to expand hospice and palliative access within their communities.”

—  Phenneger, St. Croix

“All leaders in our space should absolutely have a continual eye on year-two results [of VBID], once they get published, as well as any payer contracting in alternative payment model providers that are looking to have a negotiated rate relationship, and then maybe an ask for a reconfiguration of certain hospice services.”

— Westfall, VITAS

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COVID uncertainty still looms

“I’m worried about the triple pandemic of COVID, RSV, and the flu. I’m hoping people have gotten their vaccines, and that we get to a place where we have much broader vaccination rates. Also, it will be really important to follow what happens with some of the authorities that were available during the pandemic, and I’m hoping that those authorities are extended beyond the public health emergency.”

— Dr. Julian Harris, CEO, ConcertoCare

“If, for any reason, there was another significant wave of a variant that caused a material disruption in the health care system, that would have a ripple of consequences with it. If we got back into shutting down sites of care and real restriction of access, there would be a ripple impact of patients traversing the health care system to inevitably be identified and referred to hospice, how they access the benefit, and then even the ripple effect in the labor market. I don’t give it a high likelihood, though, based on all the science and data right now, and I hope I am right on that.”

— Westfall, VITAS

“Hospice providers know the importance of predicting the unpredictable and staying agile when met with the unexpected. That said, 2023 may bring us something unforeseen to handle, and we will have to keep our organizations nimble and flexible.”

—  Phenneger, St. Croix

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A new approach to regulatory surveys

“I think the survey reforms, the new process, was long, long overdue. You see these long gaps and just such variability of surveyors, even their understanding of what to look for. The recent letter that went to [the U.S. Centers for Medicaid & Medicare Services (CMS)] about the unregulated growth of hospices in certain states really speaks to that lack of regulatory oversight. None of us who are in the hospice industry want to see bad providers continue to go on for years and years unchecked.” 

— Ponder- Stansel, Alivia Care

“What I hope occurs is starting the barometer that was supposed to have been occurring, which is, enhanced, elevated, robust education to surveyors about the hospice benefit, and the expectations when they come on-site, what they should be looking for, and what they should be identifying and or assisting providers with identifying as part of that process. That’s a real opportunity.”

— Westfall, VITAS

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A volatile labor market

“Workforce has definitely got to be at the top of the list — not just workforce shortages, but being able to find and retain people who fit your culture. I think that for a lot of us, Agrace certainly among them, things got so tight in the labor market that it was almost like you’d hire anybody. And that can burn you because then you have people come on board who are not aligned with the mission.”

— Sexten, Agrace

“We’ve been pretty fortunate on the ConcertoCare side to recruit and deploy very talented high-quality teams, but there are broader challenges in the labor market. Hospitals are having some unique challenges, and some larger companies have shared those challenges. The market may be evolving.”

— Harris, ConcertoCare

“At Enhabit, we’re continuing to place a strong focus on how we can best support our staff. One of the main ways we support them is through our care models so they can most effectively manage their work and their personal life. This means closely watching our hiring and turnover trends, and then identifying the root cause of our turnover so we can address what matters most to our team members.”

— Jacobsmeyer, Enhabit

“I think it’s going to be a few years of real scarcity in our bedside people, and interestingly enough, a lot of us are also experiencing really severe shortages in our information technology, business office people, or accountants, to the point that some programs are outsourcing that completely. I do see that all of us are focusing more on retaining the people that we do finally get because it is so difficult to replace them. Retention has become a bigger deal than it already was.”

— Ponder- Stansel, Alivia Care

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