Liaisons can smooth out communication with docs

Follow-up surveys also can improve performance

The need to pass on advice from the Department of Health and Human Services about interpretation of the six-month rule accentuates a basic challenge that hospices face constantly: communication with physicians.

At Methodist Alliance Hospice in Memphis, TN, a physician liaison is responsible for communicating basic hospice information such as the role of the treating physician in hospice care. The marketer also gives physician information demonstrating the cost-effectiveness of hospice care.

Understanding that continued improvement will help bring more referrals, the hospice also tracks physician satisfaction. Following a patient’s death, the liaison surveys the treating physician to track ease of referral, responsiveness to physician needs, and level of communication.

Since the hospice has begun tracking physician satisfaction, physician response has prompted improvements in the hospice’s referral and intake process. "We’ve streamlined our process," says Sally Aldrich, RN, MSN, hospice director.

The most notable change has been the elimination of several phone numbers. Now, physicians and hospital discharge planners have only one number to call and are directly connected to personnel who can help. Another change has been to add night-time admission in an effort to accommodate physicians and hospitals seeking hospice care outside normal business hours.

Acknowledging physicians for their referral is important, as well. Following a patient’s death, a list of hospice services rendered to the patient and family during their stay can be sent to the physician, says Lisa Spoden, PhD, MBA, executive director of the Kentucky Association of Hospices and Palliative Care in Lexington. The correspondence should give information on the number of visits made by nursing staff, social workers, chaplains, and other volunteers; bereavement follow-up; who was present at death; and a personal, handwritten note by a coordinator or administrator thanking the physician and staff.

Experts offer a similar system to nurture physician referrals:

  • Members of the administrative team are assigned key doctors.
  • The team member is responsible for establishing a working relationship with doctors or key members of the doctor’s staff.
  • The means and frequency of communication should be determined between the hospice staff member and the doctor/doctor’s staff member.
  • The team member communicates patient care issues, assesses physician/patient needs, and relates new program ideas within these established guidelines.
  • The team member reports findings to hospice leaders.

It is important to give clinical and administrative staff feedback from all referral sources, such as changes in managed care policies, physician feedback, and updates on changes in the marketplace, says Spoden.

"The purpose is to help staff realize that your referral resources are important to your program," Spoden says.

Another approach to effective physician relations is to think of the referring physician as a customer on the same plane as patients and families.

Like patients and families, physicians have a set of priorities for dealing with hospice and hospice staff. These include:

  • keeping physician paperwork to a minimum;
  • hospice staff making sound, independent decisions regarding the care of their patients without having to consult the physician for minor questions;
  • when physician consultation is needed, staff providing detailed information and proposing specific solutions for physician approval;
  • good communication, including regular updates from hospice staff regarding patients’ condition.

Most hospices may think they are doing the things that compel physicians to refer patients to their hospice regularly. Yet, the only way to find out whether or not those needs are being met is to actually ask physicians if they are satisfied with the care provided to their patients and with the support given to them.

Start by tracking referrals of all referring physicians, and look for physicians whose referrals have dropped off from month to month or over the course of a year. If they aren’t referring patients with the same frequency, the hospice must find out why. If the hospice’s tracking system identifies a physician whose referrals have declined over several months or after an annual review of referrals, a hospice representative should be dispatched to the physician’s office to find out why referrals have diminished.