SueAnn Reynolds, National Nominee
Family Hospice & Palliative Care, Berne, IN

1.  What prompted your interest in serving on the NHPCO Board of Directors?

Several years ago during a NHPCO plenary session, Don Schumacher addressed hospice leadership and conveyed concern that many hospice, pioneering leaders who were involved in national leadership roles were now retired or close to retirement.  When Don asked who would represent future leadership and assist NHPCO to carry on their mission, I remember thinking to myself that I want to be that future leader for NHPCO.  Now that I have had a brief exposure to the Board of Director role with NHPCO as the Great Lakes Representative, I would like the opportunity to extend my opportunity to serve and benefit the organization and its members.

2.  What special expertise would you bring to the board? 

The expertise that I’d bring is my inherent ability to be a creative visionary.  As a smaller hospice provider in northeast Indiana, we have been able to implement numerous quality programs/initiatives that larger hospice programs are able to develop, such as: recruitment of 4 Board Certified Hospice & Palliative Care physicians, an in-home blood transfusion program; palliative radiation and chemotherapy; two NF Partnership Programs; a physician/nurse practitioner palliative consultation program; and a NF 10-bed palliative care wing for step down hospitalization care or as an alternative for hospitalization for pain and symptom management.  As I have envisioned the future for hospice’s role in the future, I have already taken steps to establish our organization for such positioning in the healthcare continuum by acquiring a home health agency and developing an infusion therapy program.

I also have numerous regulatory relationships and stay very current with regulatory issues due to the following interactions: Palmetto GBA Hospice Coalition, Palmetto GBA Provider Outreach & Advisory Group, CMS Region V and Medicaid Workgroup meetings.

My numerous years of state and national committee/board involvement has cultivated my expertise to serve the goals of the NHPCO board in positioning NHPCO as the leader in the end-of-life care continuum.  

3.  How can the NHPCO meet the needs of a diverse group of hospice and palliative care providers? 

I believe that NHPCO is already meeting the diverse needs of hospice provider members through its leadership, which has strategically positioned itself to meet and anticipate these needs.  NHPCO does not exhaust its operational pursuit in meeting these diverse needs whether it is through the multiple resources it provides, the magnitude of quality educational offerings, the constant regulatory and legislative updates, the ability for provider connectivity through MyNHPCO, and the multitude of national and international collaborative relationships. 

An area for potential enhancement is to become a stronger leader in palliative care.  CAPC has captured the leadership role for palliative care, but it is too one-sided (hospital based programs).  I know there are numerous hospice programs that have established or are willing to establish non-hospital, palliative care programs and need strong, national leadership to guide and represent their interest.  While augmenting their leadership role in palliative care, NHPCO would foster innovation and member engagement among its provider members.  Through further education, the establishment of Best Practices and research, NHPCO leadership could advocate for a simultaneous reimbursement stream for palliative care.

4.  What leadership positions, beyond hospice and palliative care, have you held?

Prior to my involvement with hospice and palliative care, I focused on another cause related to people who suffer from headaches and migraines.  I established and facilitated a support group from 1998 to 2000 entitled, “Support Group for People Challenged with Headaches & Migraines,” in Wells County, Indiana. 

 I served on the Election Board in Blue Creek Township of Adams County, Indiana from 1989 to 2006.   In the later years, I held the highest position, Inspector, on the Election Board.  In 1995, I was elected to serve as Precinct Committeeman for Blue Creek Township and held the position until 2007.

I have held the following leadership roles within my church:  Education Committee Chairperson – 1999 -2000, Sunday School Superintendent – 1995 – 2000, Church Council Member – 2003 – 2004, and Sunday School Teacher 1995 – present.

Since joining Family Hospice & Palliative Care, I have been involved with 3 Chambers of Commerce and Berne Rotary.  I became a Board Member for the Decatur Chamber at the beginning of 2011.

5.  What roles do you think hospice and palliative care should play in the health care continuum that it currently does not?

CMS and third-party payers are removed from patient concerns, the practical operations of healthcare, and how to best manage the two well within a quality healthcare system.  International comparative research demonstrates that the American Healthcare System continues to rank below all industrialized countries in relation to positive healthcare outcomes while our country spends more healthcare dollars per capita.   I believe that the American Healthcare System is too fractionized, therefore set up for redundancy and failure.  A patient can easily be seen by numerous specialists with none of them communicating with each other in regards to diagnostics, procedures and treatments.  Patients are left with physician-directed goals, numerous treatments that may be counter intuitive, and under-treatment of symptoms. 

Hospice and palliative care providers are good case managers and advocators for patients.  Our primary focus is quality of life for the patient within the best cost-savings treatment plan.  CMS and third-party payers should utilize hospice and palliative care providers to case manage chronic conditions so short and long-term goals of care can be explored with the patient and less cost effective options could be offered while enhancing patient’s quality of life.  Hospice and palliative care providers would eventually become chronic care case managers. 

6.  What do you think are the most important issues/challenges facing hospice and palliative care in the next five years?  What do you see as NHPCO’s role with regard to those issues?  How would you as a board member help NHPCO fill that role?

The most challenging issue for hospice and palliative care providers will be the ongoing reduction in reimbursement while the government enhances scrutiny with the goal for monetary recoupment.  Furthermore, the continuing regulatory demands will require more staff time away from patient care, therefore placing additional financial burden on hospice providers to enhance staffing if they want to maintain quality service.  Access to quality care will become a significant issue for patients and families. 

NHPCO will need to continue to advocate for the reimbursement structure that will support quality, compassionate hospice care.  I also believe that NHPCO needs to help hospice and palliative care programs to strategically process how to diversify their revenue streams so that providers are not solely dependent on hospice reimbursement, which also means that NHPCO will have to become more diversified. 

As a board member, I believe that I can assist in moving this vision forward.  Within our own organization, we have already identified this need for diversification, therefore, we are participating in a state-funded pilot program entitled, “Enhanced Care,” (chronic care management in the last 2 years of life), developing an in-home/nursing facility infusion therapy program, purchased a home care agency and created a Palliative Care Unit with a NF Partner. 

7.  Describe an innovative or visionary achievement you led that had a broad effect in your community or state.

After identifying that a hospital-based palliative care program would not be successful in a rural setting, I envisioned creating a palliative care consultation program that would build upon the positive relationships that our hospice program had created with multiple nursing facility providers.  Family Hospice & Palliative Care recruited a physician who was Board Certified in Neurology, Pain Management, and Hospice and Palliative Medicine. During the first year of our Comfort-Focused Palliative Care program, the Palliative Care Director performed educational training for the Indiana State Department of Health Long Term Care surveyors about the medications palliative care would utilize in the nursing facility setting and the documentation that surveyors would expect to validate medication utilization for symptom management.

 Nursing Facilities seek out Family Palliative Care for challenging residents with any type of distressing symptom or behavior because of the respect that long-term care surveyors have for the Palliative Care Director and his approach to treatment methodology.  This has also created the beginning of acceptance with medications that nursing facilities commonly avoid due to misunderstanding or regulatory concerns but are now willing to utilize for symptom management with greater comfort due to the successes of the  palliative care program.   

In addition, four nursing facilities have established partnerships with Family Palliative Care, which encompasses our palliative care team to participate on the nursing facility’s behavior and medication management teams.  Within these partnerships, all residents with any dementia diagnosis are referred to Family Palliative Care for a consult and potential management of symptoms and/or behaviors.