Introduction
The National Hospice and Palliative Care Organization recognizes the importance of marketing and developing business opportunities for hospice and palliative care services in communities across the nation. (NHPCO, Ethical Principles, 2006) Ongoing promotion of palliative and end-of-life care services through public education as well as through marketing and business development efforts are essential components necessary to assure access to all eligible individuals who want these services.
This position statement presumes that business and marketing practices of hospice and palliative care services are carried out within the parameters of the legal and regulatory statutes that pertain to our industry. Marketing practices should also be in accord with ethical norms and values set forth in the American Marketing Association’s Statement of Ethics (American Marketing Association, 2009).
Ethical hospice and palliative care providers are sensitive to and exemplify the foundational hospice values of service, respect, excellence, collaboration and stewardship (NHPCO Mission and Values Statement, 2010). These values can both inspire and challenge providers as they promote services in the community. They can motivate hospice and palliative care organizations to achieve common goals and be known as reliable and trustworthy healthcare providers. They also establish accountability for sound ethical practice as providers enter the marketplace to provide access to hospice and palliative care. The end-of-life care community has communicated these values to the general public over many years and the public deserves to have them honored by all who provide hospice and palliative care.
The goal of the NHPCO position statement is to reinforce the need for ethical practices which will in turn ensure trust and support among those being served.
NHPCO Position Statement
1. Access to Care
NHPCO’s goal is to achieve “universal availability of comprehensive hospice and palliative care services, in diverse healthcare settings and with specific emphasis on reaching traditionally underserved populations” (NHPCO, Ethical Principles, 2006) Hospice and palliative care providers seek to remove barriers to people receiving quality palliative and end-of-life care. The foundation of such efforts is broad education. Grounding marketing efforts in education and building relationships with other providers are critical to making hospice and palliative care services available to those who need them. Since Congress enacted the Medicare Hospice Benefit in 1982, education initiatives have had a positive impact—more residents of the United States have access to meaningful palliative and end-of-life services. That progress is notable and should continue.
NHPCO recommends that hospices systematically review potential barriers that prevent individuals or groups of people from accessing quality hospice care.
2. Competition
Competition among hospice and palliative care providers should be viewed by providers in a positive framework and can be a healthy incentive to provide the highest quality service and increase access to care. As organizations develop new services and improve outcomes for effective and efficient patient/family care, they make valuable contributions to the industry as a whole.
Alternatively, if competitive practices strive only to gain an advantage based on promises that go unfulfilled or overextension of services that in essence become inducements for referrals, this leads to inferior quality and reflects poorly on the hospice and palliative care industry. This runs contrary to the goal of upholding “high standards of ethical conduct and advocating for the rights of patients and their family caregivers.” (NHPCO, Standards of Practice for Hospice Programs, 2006)
NHPCO believes that hospices must accurately represent the capacity and services of their organization in all marketing, outreach and education.
3. Customer Service Excellence and Boundaries
Many hospice and palliative care organizations have worked diligently to implement qualitative measures that facilitate establishment of standard practices that, in turn, ensure excellent patient and family care. (Family Evaluation of Hospice Care Survey, NHPCO) Most honor their responsibility to uphold the trust that is placed in them by persons at fragile points in life. However, as noted above, when marketing efforts overpromise services, trust and the quality of hospice and palliative care are compromised. Excellent customer service must be provided within the parameters that constitute clinically appropriate hospice and palliative care services which are compliant with all applicable federal and state regulations. Hospice and palliative care organizations, therefore, “assume responsibility for ethical decision-making and behavior related to the provision of hospice care.” (NHPCO, Standards of Practice for Hospice Programs, 2006)
4. Hospice and Palliative Care Organizations as Referral Sources
In addition to marketing one’s own services to the community, hospice and palliative care providers are the focus and recipients of marketing efforts by other service providers. Because pharmaceutical, durable medical equipment (DME), funeral and cremation, homecare and many other organizations approach hospice and palliative care professionals for business, it is essential to identify prevailing federal and state legal and regulatory requirements and educate all staff regarding them. It is also important for staff to be educated on the ethical norms of marketing and business development. (American Marketing Association, 2009)
NHPCO advocates that organizations have clearly stated policies for contracting with and making referrals to other community providers.
5. New Trends in Marketing and Communication
Technological advances have created an entirely new venue where marketing and public relations for healthcare services can take place. Social media opportunities are evolving at a very fast pace. Therefore, the legal and ethical considerations should reflect the rapidly changing social media environment.
“Ethical guidelines in social media are crucial for keeping us safe while keeping the Internet open for both communication and commerce…. Honesty, transparency, respect, privacy, relevance and responsibility” are foundational elements for these guidelines. (Ethics Blog, retrieved February 9, 2010) As hospice and palliative care organizations use podcasts, blogs, and social networks (e.g., Twitter, Facebook, MySpace, LinkedIn, YouTube), they must do so responsibly.
Hospice and palliative care organizations must also be aware of privacy regulations and procedures as set forth in the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy and Security Rules. (U.S. Department of Health and Human Services, Health Information Privacy, 1996)
Some of the social media tools allow for the rating of individual or organizational quality. These too must be managed responsibly to avoid ethical concerns for those using them. Privacy, liability, regulation and flexibility are critical elements that must be considered in developing one’s policy for use of social media. (Healthblawg, David Harlow, retrieved February 19. 2010)
NHPCO encourages member organizations to implement clearly stated policies that support ethical use of these electronic forums.
6. Traditional Media Marketing
The use of print and broadcast media, such as newspaper advertisements, billboards and radio, have also been valuable and effective ways of communicating with the public about hospice and palliative care services. They help educate and inform the community at large and can lead to greater access to palliative and end-of-life services.
In this realm too, however, organizations must act responsibly to ensure that statements regarding services and outcomes are based on evidence that supports any claims made in these communications and in alignment with regulatory and legal standards. In addition, if patient/family stories and images are used, one must carefully monitor the process to ensure patient/family choice and respect for confidentiality and privacy. Providers should be sure they are not violating HIPAA regulations. It is essential that organizations provide clearly stated consent forms; obtain valid, signed patient/family agreement; and keep the documentation current if such stories and images are used in media marketing.
NHPCO promotes the ethical and responsible use of patient/family testimonials in media outreach, respecting confidentiality, privacy and the physical and emotional well being of those being served.
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Download a PDF of NHPCO’s full position statement on ethical marketing of hospice and palliative care services.This includes the official statement as well as an additional commentary.
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