Hospice Advisors Case Study
Title: Starting a Palliative Care Program
Company: A Hospice Company located in Ohio
Date: January 26, 2015
Problem: Strengthen Program Development
Presenting Issues/Challenges: This hospice has a long and rich history in the communities it serves. The hospice’s strategic plan called out the development of a Palliative Care program to both expand it referral channels and offer more value to ACOs that were forming in the community. It’s ADC was 162 when we started the Palliative Care development process. There were two Board Certified Hospice and Palliative Care physicians associated with the hospice.
Plan of Action: The hospice worked with the two Board Certified Hospice and Palliative Care physicians to develop the physician’s private practice to offer palliative care services. The hospice developed a separate Medical Management company where the physician housed their palliative care practice. This was an arms lengthen relationship so as meet regulatory and compliance guidelines. The hospice provided a loan to the Medical Management to help establish the company.
The palliative care program was phased in using a three step approach:
1. Establish a SNF Advisory Board.
Inpatient Palliative Care Consultation Service. Both physicians had privileges at three hospitals. The Palliative Care Program started out by doing inpatient consults. They completed a consult and provided recommendations back to the attending physician.
2. Outpatient Palliative Care Consultation Service.
There was a large multi-specialty physician group in the community. The palliative care physicians approached the Physician Group and agreed to do Palliative Care Consult on their high utilization patients. Again, the consult was completed and recommendations were provided back to the attending physician.
3. Palliative Care Program.
The Medical Management Company hired two Nurse Practitioners to work with the physicians and they started to build a case load of palliative care patients. When Social Worker services were required, the Medical Management Company purchased these services from the hospice.
These three steps unfolded over the course of a year. A portion of the consults that were referred back to the primary care physicians ended up staying in the Palliative Care Program once it was fully developed. The program was then offered to Senior Living Communities which helped build the volume for the program.
The billing for the program were a series of outpatient physician visit codes and inpatient palliative care codes.
One year into the implementation the following were noted:
- 129 inpatient and outpatient palliative care consults were completed with a 44% conversion rate (57 patients) to a hospice admission. A new referral source.
- Three months in the full Palliative Care Program, there was a case load of 49 patients.
- The hospitals and large physician group started to call the hospice and physicians for patients they had special concerns about.
- Census grew to 201 from 162 in month 12 months.