Palliative Care Concepts, Inc.
Greenville, Ohio
Michelle A. Hobbs, RN, MS, CNP
Michelle Hobbs, a family nurse practitioner, is
president of Palliative Care Concepts, Inc., an
independent practice headquartered in
Greenville, Ohio, the county seat of rural Drake
County (population: 53,309). In Ohio, nurse
practitioners can provide comprehensive health
assessments, diagnose and manage acute and
chronic illnesses, order and interpret diagnostic
studies, and formulate care plans to manage
illness and promote wellness.
In her practice, Hobbs provides pain and symptom management, assists with advanced care planning, assesses emotional needs, offers psychosocial and spiritual support, and identifies and accesses community resources. She has prescriptive authority through a pilot project at Wright State University in Dayton, Ohio, and is required to practice within a collaborative agreement established with one or more physicians. “I’ve focused my practice on palliative care for patients of all ages and in all settings,” explains Hobbs, who sees her patients wherever they are—at home, in a nursing home, in the hospital or in an assisted-living facility.
Hobbs is the only nurse practitioner on the medical staff at Wayne Hospital in Greenville, Ohio. Patients are referred to her by physicians, who consider her services an extension of the care they provide, or by nurses and social workers in hospitals and nursing homes. Patients also call her directly after hearing about her services from a friend or reading about her in the local newspaper.
Overcoming the Challenges
Hobbs overcame some major hurdles when she
started her practice two years ago. “I was one of
the first nurse practitioners in this county and
the very first to start an independent practice,”
she explains. “Many people were unfamiliar with
nurse practitioners, and palliative care was not
well understood.”
With the support of local physicians, Hobbs began to provide an additional service—a wellness program that helps patients newly diagnosed with chronic, potentially terminal illnesses stay as well as possible while living with progressive disease. Patients and caregivers in this program are educated about their specific disease condition, medications and plan of care. Patients also participate in advanced care planning to ensure that their wishes are always honored. In addition, Hobbs introduces patients and families to community resources that can assist with practical needs. She also conducts a Care for the Caregiver class, in which she teaches how to care for an ill loved one and offers practical advice to caregivers in dealing with their own psychosocial and spiritual concerns.
The majority of Hobbs’s patients reside in nursing homes. She has provided consultation in six area nursing homes to ensure that patients receive adequate pain and symptom management. She is now working with these nursing homes to implement a demonstration project designed to build palliative care teams and change policies and procedures to provide a full range of palliative care services.
Paying for Practice
After two years, Hobbs’s practice is self-supporting,
sustained by reimbursements and
fee-for-service revenues, and is not underwritten
by any medical institution. She has her own
Medicare and Medicaid provider numbers and
bills patients or their third-party payers directly
for consults and care. Some HMOs do not reimburse
any nurse practitioner services, however
Hobbs has found this exclusion to be rare.
Extending a Successful Approach Through Education and Service
Hobbs believes that nearly 100 percent of her
patients experience some improvement in their
symptoms. “My patients and families feel more
in control in a very out-of-control situation,” she
says. “In the past, patients have had to choose
between aggressive curative treatment or
comfort-oriented care. Palliative care brings those
two ends of the spectrum together, allowing
patients to be comfortable from the time they
are diagnosed with a potentially terminal illness
through the moment of their death.”
Hobbs, who chairs the pain committee at Wayne Hospital, has presented many pain education seminars. She is also a member of the faculty at Wright State University, where she is exploring ways to weave palliative care into undergraduate and graduate nursing curricula. Hobbs has conducted research examining pain assessment and treatment in cognitively impaired elderly and has given a number of seminars in Ohio on this topic. She has also presented a teleconference for the Hospice and Palliative Nurses Association and serves as an expert on the association’s “Ask the Expert” Web page.
She believes the Wayne Hospital model is ideal for implementation in rural communities where no one health care organization or facility can support a full palliative care program. Palliative care services led by a nurse practitioner can be woven throughout the existing health care structure of a small community.
Personal Reflection
Hobbs advises nurses exploring APN practice of
palliative care to “know you can make a huge
difference in people’s lives. APNs have a
significant body of knowledge, experience and
expertise. Our autonomy allows us to care for
patients and families in truly innovative ways
and fill gaps in the current health care system.”
