Open Access" is an important issue in health care today, including the Hospice setting. Preliminary findings and discussions suggest that, even amongst Hospice administrators and staff, there may be a variety of definitions of "Open Access" and views of how hospices operate in this area.
In an effort to better understand this issue, members of the National Hospice Work Group and the senior administrators at their hospices are participating in this study.
National Hospice Work Group Open Access Survey
In the course of discussions among National Hospice Work Group members, it became apparent that even among this group of high performing, innovative hospices, there appeared to be differences in interpretation and operationalization of “open access”. Thus, in early 2005 the Medical Directors Forum, under the leadership of Cameron Muir, MD developed a survey designed to explore “open access” practices and policies among National Hospice Work Group members, from the perspective of multiple members of the leadership team. Survey results were meant to further the discussion of open access among NHWG membership. An initial survey was distributed to NHWG hospices in Fall, 2005. Sixty-two responses were received from 17 hospices, from CEOs, Medical Directors, CFOs, Clinical Directors, Directors of Admissions, COOs and other hospice leadership (1 – 7 responses per hospice). The initial survey results raised additional questions particularly regarding processes utilized for making decisions regarding specific interventions or tests. Therefore, a second survey, designed to obtain deeper understanding of these issues was distributed in Spring, 2006 to all NHWG hospices. The second survey was specifically limited to responses from CEOs, Medical Directors, CFOs and Clinical Directors. Fifty-six responses were received from 21 hospices (1 – 4 responses per hospice). The surveys found marked uniformity in definitions of open access across respondents, including “all who qualify”, “remove barriers” and “offer options”. That said, there were differences in the actual implementation and “open access” models being followed. Most respondents indicated that their hospice utilized a case-by-case evaluation rather than making “blanket” decisions. Review/oversight was frequent, with the Medical Director taking the most active role in making these decisions. The most commonly cited barrier to open access was cost. Most respondents were satisfied with their current status regarding open access.