Expert advice on 'growing' your average daily census

Train to obtain more bang for your buck

Hospice professionals may loathe using the words 'sales,' 'marketing,' and 'customers' to describe what they do to improve their average daily census, but these words will need to be considered if a hospice is to remain competitive in today's industry, an expert says.

"Today's world of hospice is very competitive, and you have very fine hospices that have served the community for many years who are now suddenly faced with a lot of new competition," says Michael Ferris, managing principal of Home Care and Hospice Marketing Solutions of Chapel Hill, NC. Ferris works with hospice programs to develop their sales, marketing, and customer service programs.

"So we've been working with those organizations to help them look at what they are doing currently to get the word out and to make sure referral sources and the medical community understand what it is they do and how it is they are different from others serving their market," Ferris says.

"We look at the average daily census (ADC) as the most common way to monitor the success of efforts to improve sales, marketing, and customer service," Ferris says.

"If we see a growth in ADC, then we're doing something right," Ferris adds. "The two objectives in bolstering sales and marketing programs are to increase the number of patients admitted to hospice services, getting patients into hospice service earlier, and increasing the length of stay."

Ferris has seen hospice programs that have doubled or tripled their ADC over a period of a year or two once they've focused on specific sales and marketing strategies, which he outlines here:

1. Improve training of sales team.

"Of course when you're talking to nurses and social workers and others, the word 'sales' may make their skin crawl," Ferris acknowledges. "So sometimes the key is in how we frame it when working with staff."

For example, the outside sales team might be referred to as the community outreach or community/physician liaison team, he says.

And the on-site sales team could be the intake and admissions staff, he adds.

Whatever the sales team is called, the key is to not react to new competition in the knee-jerk way of adding more staff without first assessing the organization's ability to train staff in a way that will provide the desired outcomes of increased referrals, Ferris says.

Hospices that handle the situation that way will have a hard-working team that has not been trained to be effective at selling hospices services in the community, he explains.

Training should include the intake and admissions staff, and here are some things to consider with their training:

  • Intake/admissions employees should not view themselves as order takers or gatekeepers who ask a lot of questions to evaluate whether a proposed patient qualifies for hospice care, Ferris says.

"We've found that anytime we can make the other party's life easier, then we'll be the preferred place to call for a referral because we're easier to work with and because they can give us basic information and we'll take it from there," Ferris explains.

All that's really needed from a referral source is the patient's name and contact information, Ferris says.

Typically, discharge planners, when making a referral to hospice, will give the hospice the first page from the chart, which has most of the necessary information, including the physician's information, emergency contact information, power of attorney, diagnosis, contributing diagnoses, hospital admission dates, etc, Ferris says.

Surveys of discharge planners show that they most desire responsiveness from a hospice, he says.

"They need to call and know somebody will be there quickly to take care of the patient," Ferris says. "So it comes down to service and making their life easier."

  • Obtain marketing buy-in from all employees.

"It really does all come back to mission, and our mission is to make sure that everybody in the community who would be appropriate for hospice care is advised by their medical professional, or knows from our community outreach efforts that hospice is an option," Ferris says. "And they should have the information and accessibility to hospice to make that selection."

This means the clinical staff also need to provide the type of quality in care that results in patients' families spreading the word about hospice care, he notes.

However, if clinical employees are told to help "sell" hospice services, then there won't be a buy-in because they will take the wrong message away from this and worry about whether their jobs are secure, Ferris says.

The key is to obtain their buy-in through a focus on improving quality care.

"Ultimately, our goal is that everybody participates in the marketing efforts in some form or fashion," Ferris says. "If a hospice with maybe 200 employees encourages and recognizes the people who do something to get the word out in the community, and if everybody on the staff was responsible for one additional referral a year, then the management could look at this and say, 'Wow! That's a big number.'"

So hospices should encourage staff to mention their work at their churches, organizations, and to their relatives, Ferris says.

2. Encourage medical community to expand hospice use.

It's as important to work with the medical community to increase hospice referrals as it is to improve a particular hospice's competitive edge in existing referrals, Ferris says.

"It's not about just getting the referral that's going to a hospice and not having competitors get it," he explains. "That's important, but you can gain as much, if not more, through potential new referrals and from helping the community better understand how to use hospices."

Although discharge planners and social workers might think they know a great deal about hospice, they still could benefit from education about the many different services hospices provide, Ferris says.

One simple way to increase referrals is to train the staff working with referral sources to develop a habit of asking the following questions:

  • Do you have anybody else that we should be talking to about hospice?
  • Do you know of any other patients we should help be prepared for a hospice diagnosis?
  • Are there any patients or families you'd like us to work with, so when the time is right they'll make a good choice?

Hospice staff have to ask these questions because discharge planners are calling with their minds on one particular patient, Ferris says.

"If you jog their memory and ask them if anybody else is coming in, they might say, 'Yeah, I've got this person,' and we've made their job easier, and we have these other referrals," Ferris adds. "These really simple things can produce big results."

Hospice organizations and staff should focus on what the referral source's needs are and present the hospice as a solution to these needs, Ferris says.

This works much better than trying to "sell" referral sources on the hospice, he notes.

"We can increase referrals if we can be good at asking probing questions and getting the medical community to tell us, in their individual situations, what's important to them, what their needs are, what their frustrations are, and what patients are causing them the greatest problems," Ferris explains. "Then we can show them how using our hospice, or one of the hospice services, could help them resolve their problems and make their life easier."

3. Develop strategies for reaching new referral sources.

Each community outreach associate should be encouraged to pick up a few new referral sources, Ferris says.

"What they need to do is pick five qualified prospects, and make sure they are qualified, and have patients who would benefit from hospice care," Ferris says. "Look at each one of these individually at the account level. Who are players in the account and who actually calls in the referrals to hospice?"

While the physician, physician's assistant, or nurse practitioner might decide the patient would benefit from hospice services, there likely is someone else in the practice who calls in the referral, he notes.

"So I coach people that we should start there because that person knows what is or isn't happening," Ferris says. "Find out what's important to that person, what criteria they use, and how they determine where to make that referral."

Then that liaison person can be used to reach other people in the practice to determine what other needs can be met through a hospice referral, Ferris suggests.

"Get in front of them and make a sales pitch and you're on your way," he says.

By doing a little investigating before meeting the physician or nurse practitioner who determines which patients to refer to hospice, the outreach associate can have a very productive meeting with the actual referral source.

"So when you do get face time, you can say, 'When talking to Marge she told me this,' and you target in on the specific patient or subset of patients in their practice," Ferris says. "With physicians and others in decision-making positions, we need to help them connect the dots because they don't wake up thinking, 'I wonder if I have any patients who might benefit from hospice?'"

Again, the key is to make it easy for them by looking at their needs and showing them how you can meet those needs, Ferris explains.

"That's where you get new relationships," he adds. "And you build them from a strong foundation standpoint when you get them to give you a patient so that you can impress them with what you do."

As an industry, hospices do a poor job of getting credit for their success, Ferris notes.

"We know what a difference we've made in someone's life, but from the referral source side, we need to let them know what we've done," he adds.

Need More Information?

  • Michael Ferris, Managing Principal, Home Care and Hospice Marketing Solutions, 103 Dorset Point, Chapel Hill, NC 27516. Telephone: (919) 933-6026. Email: Web site: