Why One Hospice Provider Switched to a 7-Day Model

When a Florida-based hospice provider realized it could offer better care by throwing out the traditional five-day work week model, there were a number of issues standing in the way, including fear.

Cornerstone Hospice wanted to switch to a 7-day model, but for Rhonda White, chief operations officer of the nonprofit hospice company, doing right by patients meant having to tell staff they were about to start working weekends. The new model provided full-time care every day instead of a typical, five-day business week, and Cornerstone would have to add staff and face possibly losing some employees who didn’t want to adapt.

“When we did this, we were delicate and deliberate in the delivery [to the staff],” White told Home Health Care News. “The reaction was positive upfront for the most part. It wasn’t as difficult as we initially anticipated. We thought we would lose quite a bit of staff… but most tried to make it work within their life balance.”

Cornerstone, based in Central Florida, has been in business for more than 30 years, offering hospice services across in-hospital, hospice houses, in-home and in-patient suites. After mulling over the decision for nearly a year to switch to the 7-day business model, the provider took the initiative and found that not only were staff on board to change their schedules, but that other health care providers were enticed by the added service.

In fact, upon adopting a 7-day model, Cornerstone has seen a jump in business from referral partners and continued to grow rapidly, increasing from roughly 1,000 patients in 2015 to 1,300 patients today.

‘Ripping Off the Band-Aid’

In its previous business model, full-time staff worked Monday through Friday from 8 a.m. to 4:30 p.m. Over the weekend, Cornerstone had a “skeleton staff” of nurses on call, but patients received few visits unless in the event of an emergency.

However, hospice patients needed the same care over the weekend as they did during the week.

“There is no difference [in patient needs], that’s the problem,” White said. “That’s what motivated us to do this.”

Executives started discussing adding weekend visits to cut down on the lapse in services. Eventually, the provider went for it in 2015, referring to its jump to the model as “ripping off the band-aid.” The change allowed for continuity of care for hospice patients, and Cornerstone’s own data revealed a 7-day model could improve patient gaps and boost quality of care.

“Historically, when Monday morning nurses would come in, it was difficult to gather all the information from the weekend,” Jason D’Auria, executive director of Cornerstone’s Polk, Hardee and Highland County locations, told HHCN. “With the 7-day model, we don’t experience that same issue on Monday mornings.”

Cornerstone had to make budget adjustments in order to change its business model. Making the move to a 7-day model would not result in any cost savings; it was expected to add costs for Cornerstone.

“There was a really commitment in the leadership team to do this,” White said. “It was a change to our annual budget. This was important enough to make changes elsewhere to be able to afford the model.”

Business Boon 

In the nearly two years since Cornerstone implemented its new model, its census has grown 30%. The more impactful growth has been through Cornerstone’s referral partners, which see more value in the 7-day model and accessibility to patients. Cornerstone’s referrals make up 32% of its growth.

“[We’ve seen] an increase in referrals from our facility partners,” White said. “I don’t think we thought about those external customers as much as we did the patients.”

Cornerstone also had to beef up its physician partnerships and weekend resources for nurses to accommodate the added services it was providing.

However, the increase in business is not entirely due to the new model, according to D’Auria. Other quality initiatives were also implemented around the same time.

Surprisingly, most of Cornerstone’s staff were wiling to adapt to the new model, according to White and D’Auria. In fact, the weekend slots are the “most coveted” positions now. That may be because weekend staff were given higher salaries to work Friday through Sunday, with four days off during the week. The weekend positions are automatically $8,000 more in salary—a figure based on market comps, White told HHCN.

With more nurses working during the weekend, Cornerstone has seen a 40% boost in productivity, D’Auria said. In the last two years, the provider has seen a significant reduction in after-hours calls. As such, Cornerstone went from having 43 after-hours nurses with 1,000 patients to just 14 after-hours nurses, with 1,300 patients.

With high growth and added efficiencies, Cornerstone is hoping that its model will catch on across the hospice space.

“I wonder if people will be able to overcome the fear of not being able to staff it,” White said. “The main thing is that they have to be willing to put the money up for it.”

Written by Amy Baxter

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Amy Baxter
Assistant Editor at Home Health Care News
When not writing about all things home health, Amy fulfills her lifelong dream of becoming a pirate by sailing in regattas and enjoying rum. Fun fact: she sailed 333 miles across Lake Michigan in the Chicago Yacht Club "Race to Mackinac."

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