Hospice has been in the hot seat recently. Within the past few years, the US Department of Justice has amplified its review of claims for payment with an intense focus on hospice. In fact, the inspector general for the US Department of Health and Human Services, Daniel Levinson, addressed the issue directly in his keynote speech at the 2016 Health Care Compliance Association meeting. He announced his focus on three topics: physicians providing chemotherapy to patients who didn’t have cancer, the opioid crisis, and hospice.
“For a long time, hospice seemed like an island within the healthcare industry,” says Kate Proctor, general counsel at Seasons Hospice & Palliative Care. “Everybody would just understand why hospice was so important and why it should remain a Medicare benefit, but that has changed somewhat.” The massive increase in government scrutiny stems from hospice mirroring the uptick in healthcare spend. “Seasons Hospice has always been focused on patient-centered care,” Proctor adds. “And now we’re renewing our investment in that.”
Proctor joined the end-of-life care organization in 2014 as its first in-house counsel and took on the onslaught of new government regulations and payment reforms. Since then, her legal role expanded exponentially to handle employment risk management and more litigation in-house while growing the department as a business partner. The result: Her legal team is helping Seasons lead the way for the highest standard of care across the healthcare spectrum.
“Our caregivers, nurses, social workers, chaplains, physicians, and aides are extraordinary,” Proctor says. “And people who work in hospice administration are a special type of person. They care passionately about what we do. It’s not just a business for them.” Proctor also acquired oversight of the quality department in January 2018, which she has married with risk management. For example, families complete a survey after the patient has died to monitor and ensure the highest standard of care beyond government-measured quality indicators.
Seasons supports about five thousand patients per day and about twenty-five thousand per year, with at-home care growing organically over two decades to house twenty-nine locations across nineteen states, thanks in part to a leadership team dedicated to innovation. Due to a high density of patients relying on Medicare and Medicaid—as high as 90 percent—Proctor credits the clinical team for developing a robust eligibility process to withstand increased government regulations. For example, three different sets of people, including multiple physicians, review each potential patient to reach a consensus before admission.
“Hospice patients need to have a prognosis of six months or less by the time they come to hospice, but physicians can’t tell the future,” Proctor explains. “If the hospice physician says a patient has six months to live, but the government has a physician who disagrees, it’s essentially a battle of the experts. We developed multiple clinical resources and near constant training to help our physicians attempt to tell the future as closely as clinically possible.”
“Our caregivers, nurses, social workers, chaplains, physicians, and aides are extraordinary. And people who work in hospice administration are a special type of person. They care passionately about what we do. It’s not just a business for them.”
Risk management training is also a crucial tenet of Proctor’s compliance strategy. Since her arrival, training expanded from an annual compliance session to education across the workforce through a variety of mediums, from webinars and virtual classrooms to all-staff leadership training and in-person conferences. Discussion topics include government case studies to identify industry issues and in-house audit examples within its national network.
Today Proctor’s team is also envisioning a new care model based on hospice that’s interdisciplinary and treats the patient as a whole person while also reducing their reliance on high-cost emergency care. They often meet with hospitals, accountable care organizations, and insurance companies that are increasingly cost conscious and careful about preventing readmission.
“We’re devising new ways to provide palliative care to patients whether they are eligible for hospice or in a non-hospice context for chronic care management,” Proctor says. “We’re looking at how we can apply what we already know—how to manage pain and psychosocial issues—and create solutions for other healthcare providers.”
While she earned a juris doctor at Boston University after receiving a bachelor’s degree in history at the University of Wisconsin-Madison, she launched her career at one of the only American firms with a dedicated hospice practice representing hospices all over the country. There at Reinhart Boerner Van Deuren, about 75 percent of her work was with hospice facilities, and she credits a firm partner for the advice she follows today at Seasons: “No is not the right answer,” she says. “We have to understand the goal and figure out how to get there together in a compliant way.”
Proctor’s dedication to find a solution to any problem stems from her steadfast commitment to patient care. “Our company deals with life and death and there are times where you are going to have to do the right thing for the patient regardless of whether you will eventually be able to bill for those services under Medicare guidelines,” Proctor says. “It is such a special time to be a part of somebody’s life and make it as good as it can possibly be for both the patient and the family.”
A Wish for Those in Need
In addition to her duties as general counsel for Seasons Hospice & Palliative Care, Kate Proctor also chairs the Seasons Hospice Foundation. The organization sponsors a children’s bereavement camp, called Camp Kangaroo, in about a dozen locations across eight states. Children who have been affected by a death in the family receive counselors, art therapy, and music therapy to help process grief.
The foundation also sponsors legacy projects, from a photograph to a video story, and its own version of the Make-A-Wish program. Proctor cites one last fishing trip, a family vacation to the Grand Canyon, and the visit of a Broadway star as examples wishes the foundation has been able to fulfill.