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Hospice of the Chesapeake's Dr. Bush: Hospice Can Gain Through Primary Care First Direct Contracting

Thursday, July 16, 2020   (0 Comments)
Posted by: Katherine Lally
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To view the entire Hospice News interview by Holly Vossel, click here. 

Eric Bush, M.D., is a board-certified hospice and palliative medicine physician, joining Hospice of the Chesapeake as chief medical officer in 2016. In this role, Bush provides strategic and leadership direction to the medical staff, which includes physicians and nurse practitioners. Having served first as a licensed practical nurse in the U.S. Army Reserve, a pharmacist and then a physician in the Baltimore and Washington corridor, he brings a unique perspective to hospice and palliative care and has authored several publications in these related fields.

Bush has been featured in Hospice News webinars and at national conferences providing insights and education about alternative payment models such as Primary Care First. He will be presenting at the upcoming Hospice News event: Value-Based Care Strategies for Hospice & Palliative Care Virtual Summit.

Many in the hospice and palliative care spaces, as well as other health care stakeholders, have struggled to understand Primary Care First direct contracting payment models. Designed to help the U.S. Centers for Medicare & Medicaid Services (CMS) and health care providers reduce expenditures and improve the quality of care with Medicare fee-for-service programs, the direct contracting options include three voluntary payment models to adapt and integrate from other programs such as Accountable Care Organizations, the Medicare Shared Savings Program, and Medicare Advantage, as well as strategies used in the private sector.

How would you explain the nature of the Primary Care First payment models as they specifically could apply to the hospice space? With an obvious focus on primary care providers, what would be the draw for hospices to be interested in direct contracting models?

There are several options of the Primary Care First payment models, especially within direct contracting and what’s going to help stratify the type of entity you go in as will depend on the size of your hospice and its patients’ needs, it’s affiliates, whether you’re owned by a hospital or health system. I think you do need to also have support for palliative care and have some infrastructure already built out.

If you look at the application and the model and sift through some of the webinars from CMS, really what they’re looking at is based on some of the next generation Accountable Care Organizations (ACO) models, and it’s an advanced Alternative Payment Model (APM) type system. So, if you’re a hospice that is part of a larger organization or health system — maybe you’re owned by a hospital or a health system, and you have that type of affiliation with population health expertise in house and infrastructure — then something like the global options might be good, where there’s more risk but also possibly more reward. A lot of times these organizations have more experience with true population health management than hospice and palliative care providers. Larger entities and organizations seem more as Accountable Care Organizations, or next generation Accountable Care Organizations, and you would probably need that type of size in order to go along the lines of direct contracting.

If you’re a smaller entity and you don’t necessarily have a large infrastructure, the pro is that you have some autonomy and the con is that maybe you don’t have that population health management expertise within your organization. Something like the high-needs population, direct contracting entity option — where you have to meet a target of 250 beneficiaries that you’re providing primary care to within the first year — that’s an achievable goal for organizations of similar size to ours.

[Hospice of the Chesapeake] is applying for direct contracting as the most appealing and most appropriate to our organization at this time, the high-needs population within the professional option and with primary care capitation. While there are some home-based primary care providers, the focus is not necessarily on making sure that transition from home-based primary care to some supportive or palliative care and hospice is seamless for a coordination of care. For us, the professional option and a high-needs, direct contracting entity with a smaller patient panel works better, where we don’t necessarily have a lot of the history of risk contracting options that maybe organizations who are affiliated with larger health systems do.

We’re trying to evolve from the back end, so to speak, of providing hospice for 40 plus years and providing palliative supportive care for the last 10 years. Now, really, within the last three years, we have more of a community-based palliative care model. We were able to get our Joint Commission certification for our community-based palliative care, and we’re one of only 54 in the country with that certification. And so looking at what is the next tier of patients that we should be serving, those folks that unfortunately don’t really have a safety net out there.

There are different options for differently-sized organizations, so the intent is good and it’s good to see on a national level. It makes you think of the forest for trees. It ties into the mission and vision regarding caring for life throughout the journey with illness, loss and patient-centered care.

Entire interview here.

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