CAPC Palliative Care Discussion Forum
Palliative Care Out-Patient Services
I'm a graduate student finishing up my Master of Health Administration. I'm currently working with a team of colleagues on a culminating project--to design an outpatient palliative care program that functions within an existing oncology clinic at a local hospital.
We've been doing a lot of research, but are currently hung up on a couple of questions. We've seen a lot of information about the financial and satisfaction impact of inpatient palliative care programs, but haven't found nearly as much about outpatient programs. We are looking to find information about the benefits of having an outpatient palliative care program--especially financial benefits to the hospital. We would also love to see whether or not outpatient palliative care programs lead to less ER visits, fewer hospital stays, etc.
Does anyone have any ideas about where we could look to get this information? Or any experience on how you've seen outpatient palliative care impact patients?
Thank you for your help!
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Financial Impact of Outpatient Palliative Care
What you are searching for is the holy grail of outpatient palliative care - a concise and logical argument for cost savings or revenue generation based on evidence. Unfortunately, the financial case in palliative care is much harder to make (you can console yourself with the knowledge that the financial case for any outpatient service that bills E and M codes is challenging to make). Most often we recommend the following: 1. Make your service indispensable to some service that does generate revenue. Likely targets include cancer treatment programs or cardiac programs. Get that service to help defray the cost of your program. 2. Identify a target population and an outcome that will be compelling to your financial stakeholders - for example if your health system executives are preoccupied with readmissions and the current 30 day re-admission rate among Medicare recipients is 28 percent, develop a clinic to improve symptom management, in-home support, and care transitions for persons with advanced heart failure, 3. Sell your stakeholders on the mounting evidence that outpatient palliative care improves outcomes - things like symptom burden, quality of life, and even survival. Possibly they will be swept away with enthusiasm for these very real and important outcomes and write you big checks. The truth is that you have had trouble making the financial case for outpatient palliative care because at this juncture, it is hard to make. Hang in there though - hundreds of palliative care outpatient programs across the country are waiting for some really smart and determined student to crack the code.
Posted on behalf of Elizabeth Kvale, MD
Assistant Professor
Medical Director UAB Palliative and Supportive Care Outpatient Services
Sandra Joyce Crump, Program Manager