Creating Support for Palliative Care Programs: Understanding Referral Sources

1. National Hospice and Palliative Care Organization’sPalliative Care Resource SeriesCreating Support for Your Community-Based Palliative Care ProgramDaniel Maison, MD FAAHPM

2. Introduction • Hospice staff are invited guests • Hospice organizations are dependent on physician referrals • Community partners will impact the success of a new palliative care program

3. Objectives • Understand what motivates referral sources to make decisions. • Describe three key ways to collect practical information to help serve referral sources. • Identify the main strategy for creating buy-in from referral sources.

4. Take a Step Back! • Why do your partners refer patients to your hospice or hospice at all? • What is in it for them? • If you are in a competitive environment, why would they chose your program over another one?

5. Motivation in Decision Making • It is the right thing to do • It benefits me in some way • It benefits someone I care about (patients) in some way • It is what I have always done

6. Conduct a Needs Assessment • Why don’t they refer? • Determine the type of information you wish to gather • Decide how to ask the questions

7. Many Forms of Assessment • Facilitate one on one interviews • Conduct a survey • Hold a focus group • Form an advisory board • Invite key physicians to join any and all above!

8. Challenges to Assessing Need • Labor intensive, time consuming for staff • Low response rate • Limited participation • No one best way to gather information

9. Benefits of Asking • Physicians feel “heard” • Gain buy-in • Old administrative trick – inviting biggest critic to the decision making table

10. A Coupe of Caveats • Do not be discouraged when what is requested is not what is wanted • Physicians may say one thing and want another • Trial and error are needed when trying to drill down to what a physician wants

11. Case Example 1: Lessons Learned Issue • Physician had concerns about hospice program • Never hears from hospice until after patient dies Plan • Met with physician • Outlined course of action for future referrals

12. Case Example 1: Lessons Learned What happened after next referral • Called physician for orders • Consulted at every change in patient condition • Sent death certificate • Physician did not return any communications!

13. Case Example 1: Lessons Learned New plan • After next referral hospice took care of everything and contacted physician when patient died Result • Began receiving 1-2 referrals per month (up from 1-2 per year) • Physician is ‘very pleased’ with services

14. Case Example 2: Lessons Learned Issue • Minimal referrals from large physician group Plan • Met with physician group • Barriers to referral discussed • Developed comprehensive plan

15. Case Example 2: Lessons Learned What happened next • No change in referrals or length of stay • Emergency room incident during the night • Invited head of physician group to join advisory board Result • Referrals have increased

16. Conclusion • Creating support for a new program involves understanding motivation and need. • Many ways to gather information. • The process itself is often as helpful as the information gathered. • Let those you hope to serve help shape the program you plan to offer. • Stay focused, work through challenges, and success is sure to follow.