I've been spending more of my mental energy on the subject of marketing lately than I would like. This GruntDoc post of a cartoon that shows what happens when Dilbert's doctor meets a typical drug rep sums up my dilemma well.
I'm not going to go into the specifics of my situation, but did want to reflect on this side of the hospice business since it has largely been ignored on this blog. I would like to be a hospice nurse, chaplain, social worker, admission coordinator, or volunteer coordinator, but you couldn't pay me enough money in the world to be a hospice marketer. Think about what that job entails, and tell me you want the job.
First, a hospice marketer has to be a marketer. I get mad when I'm in the waiting room of a doctors office and a drug rep comes through. I have all the respect in the world for doctors and their staff because there has not been a wave of attacks on drug reps. As a guy, it was drilled into my head that no means no. Somehow drug reps never got that lesson. "Yes, I know the doctor is back there working hard to heal people, but I must see him because (pick one) I'll get fired if he doesn't sign this paper, the samples I have will bring peace to the mideast, he loves to look at my cleavage, he promised last week that if I'd leave him alone he'd let me bug him again this week, I know he loves coffee so I brought him his 4,826th coffee mug of the year, . . . Doctors should start a group blog to tell the world all the funny stuff marketers have said at their office. Hospice marketers must do the exact same things that the drug reps do but with a smaller budget.
Second, they have to market hospice. Please stop for a minute and try to think of what you would say during the thirty seconds you get in front of a doctor. You have fought the good battle and gotten past the receptionist (who is paid a bonus for every marketer she can make leave without talking to the doctor) now you get to see the doctor. He walks out of an exam room, tells the nurse what to do for the patient he just saw, starts walking toward the next exam room and indicates without speaking that you have from now until he reaches the door to say your piece. You have 30 seconds to get him to tell you the name of a dying patient that you can take care of; what would you say? "Hey doc, any of the people who have come to you for healing ready to be shown that you are not in fact God?" or "I hear rumor that you've got a patient at the hospital who's in bad shape. How about telling she and her three children that she's going to die so that I can meet my quota and get my quarterly bonus." Seriously, what can you say that the hospice rep who talked to the doctor yesterday (and had better cleavage than you) didn't say? Hospice is not something that should be sold in this way.
Unfortunately, my money driven competition doesn't see it this way, and to stay alive I'm going to have to enter their game. Now, how do you hire a marketer when you really don't like marketers? That's my issue today. I've interviewed a marketer who has experience and, more importantly, contacts that my company could really use. She is qualified and wants the job. Yesterday, I cold called a friend who I have not talked to in a long time. She has the personality of a marketer but the heart of a saint. I'm taking her to lunch today to convince her that she should leave her current office management job and be my marketer. I have no doubt that the candidate who thinks she has the job would bring in more patients than my friend, but I know my friend will not ruin my reputation or her own while doing her job. Hospice isn't something that should be sold like a used-car, and I refuse to forget that.
Wednesday, April 27, 2005
Tuesday, April 26, 2005
Must read article
This article in the Miami Herald says some stuff that I tried to say during the Terri Schiavo mess, but it does it much better than I did. Please take a moment and read it.
Monday, April 25, 2005
You don't scare me!
I have not written anything substantial on this blog for over a week, and, as I said last week, I have all kinds of stuff I want to write. Unfortunately, I'm taking the limited time that I do have to work on the blog to blow off some steam. So, with that said, here's an open letter to those families who believe that being hostile will get their loved one better care. I'm guessing that most everyone in the medical community would sign this letter with me.
Dear ______ family,I feel much better!
You do not scare me. I know you can't believe that, but you can call me up and threaten to sue me from here to eternity and I will not miss a minute of sleep. Your hollow threats to "have your attorney" call me are always hollow. My company does not have a defense attorney because you and all those like you are bullies who can't afford to have their bluff called. I have never been sued, but people like you tell me that they will on a very regular basis. If you do pull the trigger and find a sleazy, two bit, egg sucking, ambulance chasing lawyer to represent you, the only question I will ask when trying to choose my attorney is whether they think they can get the judge to make you pay their fees also since the lawsuit is such a piece of crap.
Yes, there may come a day when either I or someone on my staff makes a mistake, but that day wasn't today. You are upset, confused, overwhelmed, and feeling more than a bit helpless, but that is no excuse to treat me or my staff they way you are. I can only hope you are acting this way out of some misguided theory that we will pay more attention to your loved one if we are scared of you. (I'd rather believe that than think that you really are this much of a jerk.) I hate to burst your bubble, but I believe your loved one's care will suffer because of your actions. Once you betray yourselves as people who want to sue us, we will be very cautious about what we say and do. The last thing you want is for us to react slowly, but having to stop and view our decisions through the eyes of a judge slows reaction time significantly. No, we are not scared that you will win, but we'd rather not have to waste our time with your baseless lawsuits. We won't work harder or faster and I can almost guarantee that we won't be as aggressive as you are going to want us to be.
So, sit down, shut-up, and let me do my job. We are good at what we do, and you are lucky that you have us. Do what you want, but I'm just telling you that the faster you change your attitude the better it is for everyone involved.
Saturday, April 16, 2005
Profit vs Not-for-Profit
The debate continues. From my experience there are sufficient examples of not-for-profits doing a poor job and for-profits which do an admirable job. Nevertheless, the embedded link from Medscape offers food for thought and should challenge us all. http://www.medscape.com/viewarticle/474306?src=search
Friday, April 08, 2005
Joe Oncology
I was recently pointed toward a new blog that, although it is not about hospice, has much in common with my goals here. The blog is named Joe Oncology, and has been added to the blogroll on the right. His discription of his job is probably a better summary of my job than I've ever written.
He said:
I couldn't have described the challenges of my job any better.
Welcome to the blogosphere Joe.
He said:
It's an interesting challenge trying to provide compassionate care while at the same time balancing the budget so you may continue to provide compassionate care.
I couldn't have described the challenges of my job any better.
Welcome to the blogosphere Joe.
Thursday, April 07, 2005
Hospice cost savings
In the March 2005 edition of Caring (a publication of the National Association for Home Care & Hospice) I found this quote on page 25:
Here's the question that must be asked. Ignoring quality of life improvements that may come with hospice care in the home, does hospice care reduce hospitalization at the above stated rate. The answer is no; hospice reduces hospitalization much more than that!
I remember well one admission that I had trouble doing because the patient kept going back and forth to the hospital. He was a cancer patient who wasn't sure that he was ready for hospice. I was going to meet with he and his mother in their home to discuss what we could do to help, but the first two meetings were canceled because he had returned to the ER for pain management which, of course, ended up in a hospital admission. After the second one, I convinced them to allow me to come to the hospital and meet with them before discharge. He ended up signing up for our service before leaving the hospital and we were able to keep his pain under control at home for almost two months before he died. Before his hospice admission he had spent 39 of the last 60 days in the hospital. How much money do you think hospice saves the system on patients like this?
Let's do some quick math problems. Both examples below are an overview of the final 60 days of a patient's life and are very conservative in my opinion. I have also assumed (guessed) that pronouncing death at an emergency room takes only 1/2 of the usual $5,000 spent on an ER patient and have not included the cost of the EMS services for each trip to the ER.
Example 1:
Most end stage COPD patients/families freak out on a somewhat regular basis when the patient is having trouble breathing (it's hard to watch someone you love suffocate); without hospice that freak out ends up with a call to 911, a trip to the emergency room, and possibly but not always an admission to the hospital.
Without Hospice: If the patient/family freaks out once a month that's two trips to the ER ($10,000), one three day admission ($3,000), and death pronounced at the ER ($2,500). Total for non-hospice care: $15,500.
With Hospice: The patient/family calls hospice emergency number during freak out, on-call nurse makes visit, and ER visits are totally avoided. Nurse gets medications changed avoiding the inpatient hospital stay. Death happens at home, death is pronounced at home (how this happens from state to state varies significantly), funeral home comes to pick up the body. All of this is part of Routine Home Care hospice rate. Total for hospice care: $6,000.
Example 2:
A nursing home patient with end stage dementia gets a UTI causing a spike in fever and discomfort. (Some patients do this every couple of weeks and others once a year, so sticking with my conservative examples we'll assume it happens every other month.
Without Hospice: Nursing home calls EMS, trip to emergency room ($5,000), admitted for 5 days of antibiotics ($5,000). Patient death is pronounced at ER ($2,500) Total for non-hospice care: $12,500.
With Hospice: Nursing home calls on-call nurse, nurse gets antibiotic order from doctor, and case is closed. Total for hospice care: $6,000.
I can go on all day. There are many studies that show that hospice saves the system money. There are also many reports that people who have used hospice think it is the best things since instant oatmeal. Do the math on that, and it seems clear that the Medicare Hospice Benefit was one of the best ideas our federal government has come up with in a long time.
It is obvious that I am a hospice advocate, so if you need to crunch your own numbers, I say crunch away. As I said, there is ample proof that hospice saves the system money, and, when you finish burning the buttons off your calculator, stop and remember that the money you just saved the system also did a lot for the patients and their families. It's a win from any angle.
That's why I just can't understand why there are still so many doctors who think hospice is a dirty word that should remain on the list with chiropractors, acupuncture, and snake oil salesmen. It's time to accept the truth and start helping those that need help get exactly what they need.
The cost savings achieved by providing care to individuals at home compared to care provided within a hospital are huge. The average cost per day for hospitalized patients last year exceeded $1,000. The cost for a visit to the hospital emergency room was more than $5,000. By contrast, the average cost for home care services is about $100 per day. Even a cursory glance at these numbers emphasizes the importance of minimizing hospital admissions, especially readmissions via the emergency room.The article deals with Home Health more than Hospice, but the numbers still ring very true. My agency is paid $105.49 per patient per day by Medicare no matter what we do for the patient that day. This means that, using very rough math, we are paid $6,000 for a patient who is on our service for two months. The same patient would rack up that much for one trip to the emergency room that resulted in a one day stay at the hospital. (We all know that there is no such thing as a one day hospital admission, but that's another subject.)
Here's the question that must be asked. Ignoring quality of life improvements that may come with hospice care in the home, does hospice care reduce hospitalization at the above stated rate. The answer is no; hospice reduces hospitalization much more than that!
I remember well one admission that I had trouble doing because the patient kept going back and forth to the hospital. He was a cancer patient who wasn't sure that he was ready for hospice. I was going to meet with he and his mother in their home to discuss what we could do to help, but the first two meetings were canceled because he had returned to the ER for pain management which, of course, ended up in a hospital admission. After the second one, I convinced them to allow me to come to the hospital and meet with them before discharge. He ended up signing up for our service before leaving the hospital and we were able to keep his pain under control at home for almost two months before he died. Before his hospice admission he had spent 39 of the last 60 days in the hospital. How much money do you think hospice saves the system on patients like this?
Let's do some quick math problems. Both examples below are an overview of the final 60 days of a patient's life and are very conservative in my opinion. I have also assumed (guessed) that pronouncing death at an emergency room takes only 1/2 of the usual $5,000 spent on an ER patient and have not included the cost of the EMS services for each trip to the ER.
Example 1:
Most end stage COPD patients/families freak out on a somewhat regular basis when the patient is having trouble breathing (it's hard to watch someone you love suffocate); without hospice that freak out ends up with a call to 911, a trip to the emergency room, and possibly but not always an admission to the hospital.
Without Hospice: If the patient/family freaks out once a month that's two trips to the ER ($10,000), one three day admission ($3,000), and death pronounced at the ER ($2,500). Total for non-hospice care: $15,500.
With Hospice: The patient/family calls hospice emergency number during freak out, on-call nurse makes visit, and ER visits are totally avoided. Nurse gets medications changed avoiding the inpatient hospital stay. Death happens at home, death is pronounced at home (how this happens from state to state varies significantly), funeral home comes to pick up the body. All of this is part of Routine Home Care hospice rate. Total for hospice care: $6,000.
Example 2:
A nursing home patient with end stage dementia gets a UTI causing a spike in fever and discomfort. (Some patients do this every couple of weeks and others once a year, so sticking with my conservative examples we'll assume it happens every other month.
Without Hospice: Nursing home calls EMS, trip to emergency room ($5,000), admitted for 5 days of antibiotics ($5,000). Patient death is pronounced at ER ($2,500) Total for non-hospice care: $12,500.
With Hospice: Nursing home calls on-call nurse, nurse gets antibiotic order from doctor, and case is closed. Total for hospice care: $6,000.
I can go on all day. There are many studies that show that hospice saves the system money. There are also many reports that people who have used hospice think it is the best things since instant oatmeal. Do the math on that, and it seems clear that the Medicare Hospice Benefit was one of the best ideas our federal government has come up with in a long time.
It is obvious that I am a hospice advocate, so if you need to crunch your own numbers, I say crunch away. As I said, there is ample proof that hospice saves the system money, and, when you finish burning the buttons off your calculator, stop and remember that the money you just saved the system also did a lot for the patients and their families. It's a win from any angle.
That's why I just can't understand why there are still so many doctors who think hospice is a dirty word that should remain on the list with chiropractors, acupuncture, and snake oil salesmen. It's time to accept the truth and start helping those that need help get exactly what they need.
Tuesday, April 05, 2005
Grand Rounds
Another week, another edition of Grand Rounds. This one is very simple to navigate, and there are quite a few good personal posts about the life of a doctor that I really enjoyed.
Go check it out.
Go check it out.
Monday, April 04, 2005
Monday morning housekeeping
There are a few little things that are sort of hanging around on the blog; none of them are actually big enough to write about on their own, but I still feel that they should be mentioned.
First, I'm still shocked by the amount of interest in generic duragesic patches. I first posted on the new generic duragesic patches on February 23rd. That post filled my box with e-mail so I did more research and posted an update a month later. I have not posted on the subject since then, but over the weekend 28% of the people coming to this blog via search engine came after searching for generic duragesic. The only thing new that I have to report is that the generic patches that our pharmacy is using (the ones that are real duragesic patches sold by another name) seem to be working well. We have not tried the other generic brand, so I don't know if it really is a bad product.
Second, the post written by Administrator in Motor City about "Uncle Charley" was removed last week because of a technical glitch that we couldn't figure out. AIMC brings a fresh perspective to this blog, and I hope he posts more often. (Being a good member of the GOP I didn't like his anti-Bush slant in the post, but we're all grown up enough to support different political beliefs. That is not why the post was removed.)
Finally, no, I will not tell you what is on my list. I've received a couple of e-mails from people who currently have family members on hospice asking me to tell them "in private" what my list is. The list is personal and may well deal more with my personal fears than the things that you would fear. Telling everyone who comes across this blog what I believe to be the worst way to die can serve no purpose other than to make people with that condition more fearful than they already are. Sorry, but I see no good coming from telling anyone what my list contains.
Ahh, now I feel better. Time to move on to more important things. If North Carolina wins the basketball game tonight I will win the pool.
First, I'm still shocked by the amount of interest in generic duragesic patches. I first posted on the new generic duragesic patches on February 23rd. That post filled my box with e-mail so I did more research and posted an update a month later. I have not posted on the subject since then, but over the weekend 28% of the people coming to this blog via search engine came after searching for generic duragesic. The only thing new that I have to report is that the generic patches that our pharmacy is using (the ones that are real duragesic patches sold by another name) seem to be working well. We have not tried the other generic brand, so I don't know if it really is a bad product.
Second, the post written by Administrator in Motor City about "Uncle Charley" was removed last week because of a technical glitch that we couldn't figure out. AIMC brings a fresh perspective to this blog, and I hope he posts more often. (Being a good member of the GOP I didn't like his anti-Bush slant in the post, but we're all grown up enough to support different political beliefs. That is not why the post was removed.)
Finally, no, I will not tell you what is on my list. I've received a couple of e-mails from people who currently have family members on hospice asking me to tell them "in private" what my list is. The list is personal and may well deal more with my personal fears than the things that you would fear. Telling everyone who comes across this blog what I believe to be the worst way to die can serve no purpose other than to make people with that condition more fearful than they already are. Sorry, but I see no good coming from telling anyone what my list contains.
Ahh, now I feel better. Time to move on to more important things. If North Carolina wins the basketball game tonight I will win the pool.
Friday, April 01, 2005
Seems like a good time to pray
Time to ignore my post from yesterday about the Pope living on life support, because things seem to be moving quickly.
One of the most often repeated lines by any hospice worker is, "We can't ever predict when someone is going to die." We can see it coming, we have a good guess of what is going to happen next, but timeframe is something that you just can't predict.
With that said, it sounds very much like the Pope won't see Sunday morning and probably won't see Saturday. Quite obviously I don't know any more than what the press reports about his condition. Here is what I do know. When they announced yesterday afternoon that the Pope had a fever from a UTI, we were sitting around the office listing the things that would happen next if the Pope were one of our patients. I'm sure we all feel a bit awkward this morning, because they have happened much like we said they would. This morning's guessing game had nothing to do with what is going to happen next, because what happens next isn't something you joke about. We have now had our coffee and talked about the symptoms the Pope has that are not being reported.
I say all this to say that it seems today is a day where those of us who pray should be doing it a bit more than usual. I'm sure most will be praying for the Pope, but I'm praying for his followers. I'm guessing that the Pope's path to heaven is secure, so I'm going to spend my time praying for the Catholic Church. Again, I'm not Catholic, but the church in the United States is in a lot of trouble. As the church goes through a period of mourning and change, I pray that God's will be done.
One of the most often repeated lines by any hospice worker is, "We can't ever predict when someone is going to die." We can see it coming, we have a good guess of what is going to happen next, but timeframe is something that you just can't predict.
With that said, it sounds very much like the Pope won't see Sunday morning and probably won't see Saturday. Quite obviously I don't know any more than what the press reports about his condition. Here is what I do know. When they announced yesterday afternoon that the Pope had a fever from a UTI, we were sitting around the office listing the things that would happen next if the Pope were one of our patients. I'm sure we all feel a bit awkward this morning, because they have happened much like we said they would. This morning's guessing game had nothing to do with what is going to happen next, because what happens next isn't something you joke about. We have now had our coffee and talked about the symptoms the Pope has that are not being reported.
I say all this to say that it seems today is a day where those of us who pray should be doing it a bit more than usual. I'm sure most will be praying for the Pope, but I'm praying for his followers. I'm guessing that the Pope's path to heaven is secure, so I'm going to spend my time praying for the Catholic Church. Again, I'm not Catholic, but the church in the United States is in a lot of trouble. As the church goes through a period of mourning and change, I pray that God's will be done.
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