For-profit hospice growth due to marketing, quality

There’s room for more growth for all

As for-profit hospices grow and gain market share in the hospice industry, their nonprofit counterparts might learn a few new tricks from them about marketing hospice services to the public.

VistaCare Inc. of Scottsdale, AZ, has plans to grow by reaching more of the people who are eligible for hospice services, says David Rehm, MSW, senior vice president.

"Our first focus is professional referral sources, because when family or patients are making a decision about needing hospice care, they are almost always in the active care of a physician," Rehm says.

Quality measured internally

"We have a real commitment to quality in our company and have high standards for internal quality measures," Rehm says. "And we have an internal survey process where all sites are surveyed annually, and we indicate that to our referral sources, as well."

While a hospice can grow initially through aggressive marketing and sales efforts, the only way growth can be sustained is if referral sources and health care professionals believe that a hospice consistently provides high-quality care, Rehm notes.

"That’s a key driver for any kind of sustained growth," he says. "That’s the first focus, and the second focus is on the community itself and the patients themselves."

To reach the community and potential patients, VistaCare has developed a variety of educational materials, including brochures and advertisements, Rehm says.

"Our staff will speak to groups, and we’re always trying to educate people about hospice in general and the options people have at the end of life," he says. "We have them think about what course of care they will need to pursue, and we have a sophisticated array of support tools that can be employed."

In addition, VistaCare was the first in the hospice industry to develop national media programs through a partnership with the consumer health care web site WebMD Health, Rehm says.

WebMD Health has more than 20 million visitors each month. With VistaCare’s support, WebMD Health began in October 2004 to offer Caregiver University, a four-week course offered on-line for people who need to learn more about the realities of caregiving, Rehm says.

"The other thing we’ve done is provide a professional course that offers [continuing education] credits for physicians and nurses in the area of end-of-life care and palliative medicine," Rehm says. "This course certainly benefits VistaCare, and of the 5,000 people who took it, 30% might be in the communities we serve."

VistaCare has a 60-second advertising spot about hospice on NBC’s private television network that provides programming in patient rooms in more than 1,000 hospitals around the country, Rehm says.

"We sponsored it around end-of-life issues and talk about a whole range of needs and questions," Rehm says. "We have an advertising spot about hospice and finish with VistaCare’s name and phone number."

Nonprofit expansion strategies

While VistaCare is working on increasing its and the industry’s market for hospice services, some nonprofit hospices are coming up with their own expansion strategies.

For example, the Hospice of Marin in Corte Madera, CA, also has a strategy of expanding geographic boundaries, says Mary Taverna, president of the Hospice of Marin Foundation and chairwoman-elect of the National Hospice and Palliative Care Organization (NHPCO) in Alexandria, VA.

"While hospices in the past were, maybe, a community or county provider, now we have to look differently at this and wonder whether that will ensure long-term survival," Taverna says.

The hospice has expanded to three counties and split into two separate entities as part of its long-term strategy. Another major change was the recent decision to hire a new chief executive officer to handle the hospice side of the business, while Taverna stepped down from that role and became the foundation’s leader, she says.

"I invested so many years into this organization and cared deeply about it, and I wasn’t going to be a passive leader as I saw this industry changing," she says.

The hospice’s flexibility in changing with the times seems to have worked. Despite the increased competition, the hospice’s census has never been higher, and the growth has all come from an increase in non-charity-care patients, Taverna says.

The combination of marketing strategies being deployed in the hospice industry might be contributing to the industry’s overall growth.

According to A Data Book, Healthcare Spending and the Medicare Program, published in June 2004 by the Medicare Payment Advisory Commission (MedPAC) in Washington, DC, growth in hospice use has been fastest among Medicare beneficiaries with noncancer diagnoses, which now account for half of the hospice population, and among those who are older. The MedPAC report also notes that hospice use has increased considerably among nursing facility residents. The report notes that the three most common noncancer diagnoses for hospice patients are congestive heart failure, dementia, and lung disease.

As growth continues, it’s important for all hospice organizations to stay focused on their core mission, says Jonathan Keyserling, JD, vice president of public policy for NHPCO.

"As general health care evolves and changes its treatment and interventions with patients, hospice has also evolved, so there’s a good fit between the two and a continuum of care — a seamless transition between life-prolonging therapy and hospice care," Keyserling says.