A commenter on the previous post about the Medicare Hospice Benefit rate cut asked if, “the ‘average’ profit margin for hospice has a lot of built in inefficient and wasteful hospices”? In his mind, if the average profit margin of hospices is being dragged down by a lot of hospices that are not being run well, then those inefficient hospices are the ones who will go away, and that’s not such a big loss.
I agree 100%. There is no doubt in my mind that there are a lot of hospices that run their organization poorly. In fact, I believe there are some hospices who wear their inefficient (or poor) business practices like a badge of honor. Often, when I hear non-profit hospices talk about the evil practices of for-profit hospices, their examples of evil are the for-profit’s focus on efficiency or tracking of minute financial details. In my mind, those are examples of good business practice, and we are far past the day when hospices can act like they are not a business. Every company in the nation tracks employee workload and works to improve efficiency, but some hospice professionals claim that this type of accountability “sucks the life” out of hospice care. They refuse to track things like the average number of visits each nurse makes, even though the visit is the core component of hospice care. If one nurse can make 20 visits a week and do the job well but another one can only do 15, then wouldn’t it make sense that you would want to review the practices of the 15 visit nurse to find out where that extra time is going? Either help that nurse figure out how to make 20 quality visits or hire another nurse to pick up the slack. That’s just common business sense, but I wonder how many hospices across the nation don’t even track that type of information. How many don’t even know that one of their nurses isn’t working up to a minimum efficiency level? Is there really anything wrong with collecting that type of information to make sure your organization is running well?
I have three different things I want to look at on this subject.
- Why inefficiency can no longer be tolerated.
- The very hard changes that hospices are going to have to accept – or making sure the main thing is the main thing.
- The scary cuts that I pray won’t have to be made – or why the hospice chaplain may become extinct.
Those posts will come another day, but it is time for the hospice industry to understand that we are being treated as a business. If you don’t accept that fact and start acting like a business you may not be providing care at all in a few years.