Quality, compliance and technology investments are becoming increasingly crucial when it comes to hospices’ recruitment and retention strategies as they seek to gain an advantage in the health care labor market.
Finding and keeping quality employees who are able to keep up with the fast pace of today’s hospice compliance landscape has become a challenging feat, according to SilverStone Health CEO Alfonso Montiel. The Dallas, Texas-based health system provides palliative, home health and hospice, among other services.
The rising volume of auditing activity in the hospice space can come with expensive costs and operational strains, which can complicate providers’ ability to invest in recruitment, Montiel said during the Hospice News Staffing Summit.
“[Compliance] is very challenging, because one mistake can create a big problem and that is a lot of money [if] somebody didn’t document things properly,” Montiel told Hospice News during the virtual summit. “We have resources [for] those kinds of troubles … hiring lawyers and going file by file to make sure that everything we do is right. But a smaller company cannot afford those things and does not have the bandwidth to have the resources. We learn so much from those instances that it has become the basis for how we train our people. We now use it for training, but it’s very challenging.”
More than half of hospices nationwide underwent multiple audits simultaneously during 2023, according to survey findings from LeadingAge, the National Alliance for Care at Home and the National Partnership for Healthcare and Hospice Innovation (NPHI).
This auditing trend is not anticipated to abate anytime soon, with several hospices strengthening staff education efforts to remain compliant. But the increased training has led to rising retention concerns.
Preparing for, responding to and appealing audits takes significant operational resources, time and education, posing potential burdens that can impact turnover, said Jennifer Lemere, vice president of clinical operations at St. Croix Hospice. The hospice provider serves 10 states across the Midwest and is backed by the private equity firm H.I.G. Capital.
The hospice auditing environment has become increasingly challenging for clinical workforces, Lemere indicated.
“The integrity issues aren’t happening in the Midwest as much … But I worry that what it has affected with all of these audits is retention as the documentation requirements continue to increase,” Lemere said during the summit. “Through that [auditing] process and working with [Celerian Group Company (CGS)] or [National Government Services (NGS)] and going through that education, we end up revamping and upping our documentation requirements. Sometimes we’re asking our clinicians to triple chart things.”
St. Croix Hospice has invested in an internal quality assurance training program designed to help nurses examine patient admission and mortality trends. The practice has led to increased staff engagement and understanding around compliance, Lemere indicated. But not every hospice has the bandwidth to afford similar training strategies, she added.
“For a smaller agency, that’s going to be harder to do, but we’ve really had to throw some resources into staying ahead of it,” Lemere told Hospice News.
Program integrity issues have heated up in the hospice space, with mounting compliance pressures that have trickling effects into retention, she stated. Much of the malfeasance concerns have focused on four hotbed states of Arizona, California, Nevada and Texas. But other regions of the country may be feeling the impacts when it comes to their ability to stand out among competing employers as legitimate operators, Lemere said.
Hospices are being thrown into an increasingly difficult and competitive workforce climate as a result of the fraud as regulators ramp up oversight efforts, according to Rexanne Domico, president and COO of Interim HealthCare, a subsidiary of Caring Brands International.
Hospice providers have long fought against common misconceptions about their services, but recent negative media attention around fraudulent actors in the space has challenged their ability to communicate their value proposition to future workforces, Domico said. To contend with the issue, some hospice leaders have leveraged technology to not only understand current hiring trends, but also potential indicators of turnover, she stated.
“We’re never going to control the negative, so to me it will be more about having a plan [of] what are three things you can put into the universe that are good to combat that [negative],” she told Hospice News during the summit. “It’s also looking at some new technology opportunities around things that predict employee behavior. [It’s] anything with engagement, data, performance metrics and maybe some of the new AI tools that are emerging. Is there a way to find trends and figure out how to focus in on areas. As our business becomes more sophisticated, there will be opportunities to do that a little bit differently and a little bit better along the spectrum.”