John Thoma, National Nominee
Hospice of Wake County, Raleigh, NC

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

I have served 18 months on the NHPCO Board of Directors and am committed to continue working collaboratively with the Board, staff and hospice leaders to:

• Support the mission and strategic goals of NHPCO
• Increase quality and raise the standards for hospice programs
• Assist hospice providers in navigating industry changes
• Advocate for and demonstrate the value of hospice and palliative care to consumers, medical providers and policy makers.

2. What special expertise would you bring to the board?  See the statement of characteristics to be evaluated for guidance on this question.

With 21 years of experience in end of life care the special expertise I bring includes:

• Chief Executive Leadership and strategic planning
• Accounting and budgeting
• Quality measurement and quality reporting
• Creating a community based palliative care program
• Home health and private duty administrator
• Capital campaigns, grant writing and fundraising
• Creating a local Aging and Disability Resource Center (ADRC)
• Merger of two non-profit hospices
• Partnership with local PACE program
• Collaboration with hospitals to develop a care transitions program
• Palliative care partnership with a Medicaid Medical Home
• Coalition building to promote utilization of advance directives
• Coalition building to promote health literacy

3. How can the NHPCO meet the needs of a diverse group of hospice and palliative care providers? (i.e. rural vs. urban, community based vs. corporate, small vs. large)

NHPCO can meet the needs of a diverse group of providers in the following ways:

• Continue to speak with one voice to policy makers as an advocate for fair reimbursement and reasonable regulatory oversight
• Work at the regional and national level to remove cultural and systemic barriers and increase access to hospice care
• Reaffirm the mission of hospice care and the value that hospice care provides to patients and families
• Reaffirm the vital role that hospice programs have in providing solutions to health care reform
• Using its quality resources, assist all providers to succeed in quality reporting and future value based purchasing
• Using its regulatory resources, assist all providers in regulatory compliance and responding to Medicare and Medicaid audits.

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

Leadership positions beyond hospice and palliative care include:

• Board of Trustees of the HOWC Foundation
• United Way of the Greater Triangle Board of Directors
• Advisory Board and charter member of the Aging and Disability Resource Center of Wake County
• Charter member of the Wake Health Literacy Coalition
• Member of the GOLD Coalition of Wake County to improve services for the elderly
• Vestry member, St. Mark’s Episcopal Church

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

Hospice and palliative care programs should play a greater role in following health care arenas:

• Post acute care transitions programs
• Home health advanced illness programs
• Palliative care clinics in medical homes
• Medical education for physicians and nurse practitioners
• Research centers – lack of evidence based practices in hospice and palliative care
• Concurrent care models
• Accountable care organizations – very limited now

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?

a.)    The most important challenges facing hospice in the next five years are:

• The aging population and growing need for hospice and palliative care
• Medicare reform, shrinking reimbursement and competition for healthcare dollars
• Increased regulation, oversight, and demands on providers
• Integration of health information technologies
• Defining and implementing quality reporting for hospice programs
• Declining length of stay and maintaining relevance within health care beyond brink of death care.

b.)    NHPCO’s role with regard to these challenges is to:

• Work with key stakeholders to affirm the value proposition for hospice and palliative care as key component of healthcare reform and as a model for care in the last years of life
• Continue to build a strong advocacy network through the Hospice Action Network and state associations
• Promote quality standards of  excellence and assist in developing tools for measuring and reporting quality
• Provide consumer education and advocacy for consumer rights to make informed healthcare choices based on patient and family goals
• Continue to provide excellent workforce training, regulatory guidance and leadership development.

c.)    As a member of the Board I will help NHPCO fill its role by:

• Supporting the organization financially
• Advocating at the state and national level for hospice providers
• Working with state Medicaid programs to increase hospice and palliative care benefits and utilization
• Supporting the work of the Quality and Standards Committee in promoting quality standards and developing new models for quality measurement and reporting
• Assisting NHPCO and provider members to develop and test new models of care along the continuum of care in the last years of life. 

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

Beginning in 2004, I worked with our organization, Hospice of Wake County, and key medical providers in our area to develop a community based palliative care program, Horizons Palliative Care, that is separate from our hospice program.  We started the program in collaboration with two local hospitals and several nursing homes with the goal of providing palliative care consultations in the hospitals and nursing homes.  The program later expanded to collaborate with physician practices to provide consultations in patients’ homes.  The home based program works closely with our home health program to provide home health services in conjunction with palliative care.

Horizons Palliative Care was the first program of its kind in our 5-county regions.  It introduced the concepts of palliative care to the local hospitals, nursing homes, assisted living facilities and physician practices and continues to provide palliative care education to medical providers.  The growth and success of the program has allowed Horizons Palliative Care to participate in statewide research and education.  The program has helped spawn palliative care programs in other hospitals and within the Medicaid medical home.  Horizons Palliative Care is currently working with the local hospitals and post acute community providers to develop a care transitions model in our region.  Our plan for the future is to incorporate Horizons Palliative Care as a separate non-profit entity.