Members in Action

Jack Byrne Center Hospice Collaboration

Ruth M. Thomson, DO, MBA and Cristine Maloney, MD

Since opening in December 2017, D-H’s Jack Byrne Center for Palliative & Hospice Care has worked closely with D-HH System member, Visiting Nurse and Hospice for Vermont and New Hampshire (VNH) to care for hospice patients from throughout northern New England. While this partnership is driven by Medicare hospice regulations—when Medicare patients are admitted for inpatient care to the Jack Byrne Center, VNH is required to oversee the care plan—the two organizations say the relationship works well.

“It’s been really positive,” says Ruth M. Thomson, DO, MBA, medical director, Jack Byrne Center. “VNH has a great team and we’ve developed a wonderful, collaborative relationship.”

“We have a fabulous working relationship,” says Cristine Maloney, MD, VNH’s Hospice medical director. “Frequent communication is a hallmark of our partnership. We are both really committed to making sure our patients have great care and that there’s a smooth transition when they are admitted and when they go home.”

Thomson says there is still some confusion about the care offered at the Jack Byrne Center and VNH’s involvement with that care. “Even though the Jack Byrne Center looks like a hospice facility and hospice is in the name, it is licensed as an inpatient unit of the hospital,” Thomson says. “We provide inpatient care for people with serious and terminal illnesses. But we are not a licensed hospice, so we provide hospice care through partnerships with VNH and other hospices. While we at the Jack Byrne Center are doing most of the 24-hour inpatient care, VNH owns the plan of care. So there has to be a really strong collaboration.”

For Medicare hospice patients to receive general inpatient care, which is the term Medicare uses for inpatient hospice care, regulations require that the care be overseen by the VNH. So, even when a patient comes into the DHMC Emergency Department and is identified as a candidate for the Jack Byrne Center, VNH needs to be the first phone call, says Thomson. “VNH helps the patient and family decide the best plan of care. If the decision is to come here, then we transfer the patient directly from the Emergency Department to the Jack Byrne Center and work on the care together. A VNH social worker will also meet with the family if they have psychosocial needs. We provide whatever help a patient and family needs, but we’re very mindful they are VNH’s patients.”

Maloney says VNH staffers are available to speak with D-HH System providers or to do hospice informational visits with families to discuss whether hospice care makes sense for a patient. “And since the VNH is a D-HH System member, I have full access to patients’ electronic medical records,” Maloney says. “So, if a provider wants to talk things over, I am happy to do that.”

VNH also has a liaison at DHMC, Erin McMahon, RN, who is available to answer questions from case managers, nurses, physicians, patients and families, and who meets regularly with patients and families at DHMC and the Jack Byrne Center. Maloney notes that the ideal hospice candidate has changed in recent years, so a conversation with her or McMahon may help determine if hospice care is the best choice. “People traditionally think of cancer patients in connection with hospice, but we are seeing more patients with dementia, CHF or CPD as a primary driver for their hospice stay. People with multiple medical problems who are chronically ill and have recurrent hospital admissions are potential hospice patients too ,” says Maloney.

While VNH focuses largely on providing care for home-based patients, Maloney says the Jack Byrne Center has helped VNH by providing intensive symptom management for patients and respite care. “Sometimes caregivers just need a break, and before the Jack Byrne Center opened, it was difficult to find facilities that would take a hospice patient for a few days. This enables caregivers to go out of town to family weddings, take a vacation or simply get some rest.”

Maloney adds that VNH has received excellent feedback from patients who have received inpatient care at the Jack Byrne Center. “The families have really loved being there. It's hard to describe the home-like atmosphere at the Jack Byrne Center, but our patients have had a really positive health care experience there. The nursing is excellent and patients feel very well taken care of in a personalized way.”

“For us, VNH is really a joy to work with,” says Thomson. “They have a strong clinical team; they’re very professional; and they are really open to partnering and collaborating, with the focus being on the patient and family.”