At the Center of Care

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Easing life’s final journey is the purpose and promise of Hospice of Central Ohio

Helping people live more fully through life’s final days is the cornerstone of Hospice of Central Ohio’s mission. Created by a group of volunteers who envisioned a day where end-of-life care could be administered with compassion, comfort, and respect, Hospice of Central Ohio (HOCO) provides essential hospice and palliative care services, regardless of a patient or family’s ability to pay.

HOCO serves nine counties with four physical locations and a fifth soon to open at The Ohio State University’s Wexner Medical Center. HOCO provides both in-home and inpatient services; the majority of patients are cared for at home, with roughly 8 to 10 percent cared for in a dedicated hospice facility, and a smaller number of individuals who receive services in a nursing home or assisted living environment.

“Thirty-five years ago, this effort started as a very small community-based program by a like-minded group of volunteers that really saw a need to change end-of-life care, and felt that the needs of the community here were not being met. They came together in partnership with a hospital and a small group of physicians, and created Hospice of Licking County,” recalled company CEO Kerry Hamilton.

In the beginning of the 21st century, the vast majority of hospices were non-profit; however, as times changed and privatization became the norm in the sector, most shifted to for-profit models. That transition drove Hamilton to seek ways to keep the non-profit hospice model relevant.

“I had worked in the for-profit industry from 2000 to 2005. I saw a shift in the environment, away from providing extraordinary patient care to a focus on profit. I was uncomfortable with that, so I accepted a position at Hospice of Dayton, and I went to work there from 2005 to 2009 as a vice president,” he explained. “Working there, I discovered amazing things about non-profit hospice and how different it can be, it really was a completely different focus on patient care and on providing service to the community. I became entranced with becoming a true servant leader.”

At present, HOCO serves approximately 370 hospice patients and another 200-plus palliative care. “We go where the patient needs us to be. We go wherever the patient calls home,” Hamilton said. “Think of hospice really as a holistic provider that covers everything from spiritual care to physician level services in a patient's home, all the way through to inpatient care. We cover that entire spectrum wherever they are. We definitely are a highly skilled area of care and we have to be very adaptable.”

Stronger Together: A Better Way Forward for the Future of Non-profit Hospice Care

As the healthcare landscape continues to change, Hamilton and a coalition of non-profit hospice care providers are working together to make sure that non-profit end of life care programs will weather the oncoming season of change.

At present, hospice care can be funded by commercial insurance, Medicaid, Medicare, or commercial insurance plans that supplement an individual’s Medicare benefits. Because hospice care is carved out of Medicare Advantage plans, coverage reverts to Medicare when a patient is approved for hospice. “Meaning that if you want hospice, you need to go back to traditional Medicare. That means for hospice that Medicare pays us. We don't need to have contracts with all of them, we don't have to set up payment agreements for all of the managed care organizations, they can't change what the hospice model looks like, they can't restrict access, they can't change the eligibility requirements so on and so forth,” Hamilton outlined.

That’s the current scenario, but in the future, Hamilton and other execs in the space are preparing for hospice to be covered instead by Medicare Advantage plans, a massive change looming on the horizon. “Every one of those plans has a different expectation, different payment structures, and it's very complex compared to traditional MCR.”

About a third of HOCO’s patients are covered by Medicare Advantage plans, with that number expected to increase. “If we take a look at how we're paid, what we’re paid, and the payment structure under Medicare, and we recognize that fully one-third or better of our patients would have slower pay, reduction of benefits, less reimbursement, and we look at what our current structure is, it would be very difficult for us to be able to absorb that and continue to care for those patients,” he continued.

Enter Ohio’s Hospice, created to preserve non-profit, community-based hospice in the state. Hamilton is the organization’s Chief Strategy Officer. “We are concerned that nonprofit community-based hospice will go away, and that's what we're trying to prevent. We're trying to blend the business skills that are used in the for-profit hospice world together with the heart, and compassion and community focus of community-based hospice, and create a new hybrid that assures the services we provide will go above and beyond the minimum services.”

Ohio’s Hospice began in 2013 as a joint venture between Hospice of Miami County and Hamilton’s former employer, Hospice of Dayton. “When Hospice of Central Ohio joined, in 2016, it was a catalyst,” Hamilton said. Ohio’s Hospice serves as a unique business management platform for its nine participating organizations.

“Fortunately, we have the support of better benefits, payroll management, marketing, educational services, better across-the-board anything you can think of that is ‘mission support.’ Blending those things together in the background allowed us to be stronger clinically in our forward-facing presentation to the community at the local level,” he clarified.

“The big picture we're looking for here is, we are coming together with other community-based hospices to create an organization that will make us all stronger in a way that hasn't been done before for hospice,” he mused. The availability of community-based hospice is a comfort to patients and families in times of difficulty, and with the help of HOCO and the Ohio’s Hospice affiliates, it will be here for generations to come.