Hospital and Program Description

Bozeman Deaconess Hospital is an 80 bed, community hospital serving a rural community of 50,000. The hospital has had an active hospice program since 1992. The palliative care consultation service started in 2005 and is staffed by part time physician, clinical nurse specialist, social worker, and spiritual counselor.

Problem

Adaptation of the CAPC model to sustain an active palliative care program in a small rural hospital.

Process

The program took 2 years in planning, including having the hospital pay for both the current physician and other team members attending CAPC conferences and a PCLC training. A business plan was brought to administration and the board who gave preliminary approval. The program is now in its third year of providing service to patients.

Outcomes

Referrals to the palliative care service in 2006 were well ahead of projections, with an increase in referrals of 85% from 2005-2006. Major reasons for referral were goals of care clarification and pain management. Physician satisfaction, which was measured through a survey process, has been consistently high. Medicare was the payor source of 85% of all patients referred to Palliative Care. A decrease in Medicare Diagnosis Groups LOC was documented. Additionally, referrals to the hospital-based hospice produced $254,214 in revenue for 2006.

Lessons learned

It is possible to develop a successful palliative care program no matter the size of the hospital. Key to our success was having a physician champion, an already established hospice program, excellent data collection and high MD satisfaction. Future directions for the program include further involvement in the cancer center, the emergency department and community nursing homes. Challenges include generating revenue and adequate allocation of FTEs.