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Data Collection and Measurement

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Post lower than expected volume
Author: mindyshah
Date: Sep 23, 2009 9:27 am
We have a 1-year old palliative consult program at a community hospital with 167 med/surg beds and 20 ICU beds. MD FTE is 0.5, with a new NP at 0.5. Our volume is lower than expected given the CAPC algorithm of 5% patients appropriate for consult with a capture rate of 20%. New Consults since Jan 09 is 126, with total encounters 470. We have marketed fairly heavily, but I think that the existing culture at the instituation, and the low referral rate by hospitalists who tend to do their own palliative care, lowers our numbers. This is putting administrative pressure on us due to financial pressures. Does anyone out there have a similar program with numbers not measuring up to CAPC's algorithms?
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Re:lower than expected volume (by TerrellVanAkenMD on 09/23/2009)
Those numbers seem reasonable in comparison to our program which has actually been running since mid-2007. I regard my position as an 0.5 FTE though we are in northern California and my stipend as medical director is considerably less than 0.5 but I do bill and collect for my services directly. (California, with certain exceptions, does not allow hospitals to hire physicians for medical services directly - a point which is often confusing when dealing with national figures and national models.)
We do not yet have an 0.5 NP but are just in the works to recruit one. Our bed numbers are similar to yours but spread between two hospitals in two communities 10 miles apart. We even have two hospitalist programs - both operating in each hospital. One is hospital aligned and one is "independent." Independent some would translate as "anti-hospital" though that might be a little strong. One of the indepedent hospitalist group is my biggest referral source while her partner in the smaller hospital is the rarest source. We have two oncologist who seldom use me until it's late and then more often for hospice set up.(I am also director of our hospice program to further confuse things.)
I believe there is a great, as yet untapped source of referrals in the outpatient and nursing home population. I initially envisioned a program that would transition across this continuum but then I realized - there's only one of me! That is why we will be looking for an NP to help tap other arenas.
We feel our "net worth" is better demonstrated by specific cases (rather than "numbers") of transfer out of the ICU, withdrawal of life support,conversion to DNR, etc. But our board and administration I realize is different than your board and administration.
Someone once said: "If you've seen one palliative care program, you've seen ONE palliative care program!" because they all tend to be unique. As time goes on that seems to remain true. Our team is going to a PCLC followup program at UCSF next week and I am very curious what we will learn since our initial visit in Oct. 2006. Good luck to your program!
Re:lower than expected volume (by ehargus on 09/24/2009)
At our hospital, which may be similar in number and culture to yours, we began in December 09 and have been able to show a cost savings to the hospital of about $80,000. Our service is bare bones (me, certified & an RN part time coordinator--3 days/week). I am fee for service and medical director (no salary). Our board and administration have been totally behind us mainly for quality reasons. It is nice to demonstrate some financial incentive besides quality to the hospital. We hope to grow and I too have a view to the big picture like you. EH
Re:lower than expected volume (by jbcassel on 09/24/2009)
Those CAPC #s are more illustrative than predictive. Lynn Spragens, the CAPC consultant/guru, has suggested that a more predictive but less intuitive approach (based on info she's gleaned from many a program) is:
a new program might expect 0.5-1.0 new referrals per staffed hospital bed; a 3-year-old program may expect 1.0-1.5 referrals per staffed bed; and a 5-year-plus-old program might expect 2.0 and above referrals per staffed bed. Like I said, not intuitive, but it seems to work pretty well. From your posting, it looks like you can expect approx ~160 new referrals in your first year, with 187 staffed beds, so you're right on target according to this predictor. Lynn's numbers have been confirmed by many programs (including our own here at VCU and the article published in JPSM in May 2009 by Radwany et al. -- with 640 beds they began with 289 consults, had 687 in their third year, and 1300 in their fifth year).
- Brian Cassel, VCU PCLC

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