Funding a Palliative Care Program
Last Reviewed: March 4, 2019Most programs combine several funding sources that can include billing revenue, investment by the home organization, partnership with health plans, and/or grants and philanthropy.
Use this toolkit to learn about financing strategies for inpatient and community-based programs, design of a business plan and budget, building financial partnerships, and operating efficiently so as to control costs while delivering high-quality care.
What’s in the Toolkit
Introduction to Payment
The basics of health care payment.
CAPC Payment Primer- What to Know about Payment for Palliative Care Delivery
Last Updated: March 5, 2019This monograph covers the basics of Medicare, Medicaid, health plans and the alternative payment models that are taking hold in the U.S. The intent is to provide a solid introduction to health plans, payment concepts and key considerations as a foundation to support sustainable relationships with payers and other risk-bearing entities. Center to Advance Palliative Care, 2017.
downloadUnderstanding Palliative Care Payment Opportunities with CAPC's Payment Primer
Last Updated: February 8, 2019An overview of payment models, health plans, and key terms for providers to understand when partnering with payers.
watchPayment Glossary
Last Updated: March 5, 2019Defines key terms in payment vocabulary. Center to Advance Palliative Care, 2017.
downloadWays to Pay for the Palliative Care Program
Financing methods for the palliative care program, including billing revenue, investment by the home organization, partnership with health plans, and/or grants and philanthropy. To learn how to make the case to financial stakeholders, see the related CAPC toolkits at the bottom of this page.
Optimizing Billing Practices
Last Updated: March 4, 2019Toolkit with billing and coding best practices for palliative care services delivered in the hospital or the community.
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Philanthropy Strategies: Creating a Palliative Care Advisory Board
Last Updated: March 11, 2019Recruitment, sample advisory board roles and responsibilities, and fundraising planning. Icahn School of Medicine at Mount Sinai, 2018.
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Philanthropy Strategies
Last Updated: February 3, 2019A presentation on how to request philanthropic funding. Center to Advance Palliative Care, 2018.
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Last Updated: February 19, 2019Guidance on making the case to organization leaders to secure budget for program startup and program operations.
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Payment Arrangement Options
Last Updated: February 3, 2019List of payment models that have been used for community-based palliative care services, along with their pros and cons for providers.
members loginAlternative Payment for Palliative Care: Getting from Here to There Webinar Recording
Last Updated: February 6, 2019 watch
Potential Payer Partnerships
Last Updated: February 3, 2019Overview of the range of potential financial partners for community palliative care.
members loginCAPC Payment Accelerator: Building a Financially Sustainable Palliative Care Service
Last Updated: March 4, 2019Tools to develop financial partnerships including: making the case, contracting considerations, and how to use legal and financial advisers.
viewEstimating Volume and Capacity
A sustainable business plan depends upon making realistic assumptions about patient volume and staff capacity.
Hospital Patient Volumes and Characteristics Worksheet
Last Updated: January 29, 2019Estimate patient volume using national comparative data from the CAPC National Palliative Care Registry. Center to Advance Palliative Care, 2015.
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Hospital Palliative Care Program Staffing Worksheet
Last Updated: January 29, 2019Project staffing FTE per discipline based on expected patient volumes. Center to Advance Palliative Care, 2015.
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Community Palliative Care: Estimating Average Time/Visit to Determine Capacity
Last Updated: January 29, 2019Template and example for estimating time per patient visit for a new visit and for follow-up/subsequent visits, including a calculator for generating a weighted average visit time. Center to Advance Palliative Care, 2017.
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Community Palliative Care: Estimating per Provider Visit Capacity
Last Updated: January 29, 2019Uses your time per visit estimate to project the number of visits a clinician will make per year, at different assumptions of weighted average hours per visit and annual visits per patient. Center to Advance Palliative Care, 2017.
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Home-Based Palliative Care: Pricing
Last Updated: February 3, 2019Estimating patient volume by referral type, time per encounter, and staff capacity. Center to Advance Palliative Care, 2018.
members loginEstimating Costs and Prices
Using service volume and staffing estimates to project program costs.
Hospital Impact Calculator
Last Updated: March 1, 2019The Palliative Care Hospital Impact Calculator is designed to help you project overall cost savings for your inpatient palliative care consult service.
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Estimating Cost per Patient Visit for Direct Provider Time and Patient Support in Community Settings
Last Updated: January 29, 2019For community programs. Cost estimates for patient visits based on average cost per FTE and assumptions about visits per year.
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Template for Estimating Staff Costs for a Visit and a Patient
Last Updated: January 29, 2019Model your assumptions about costs based on the variables of staff cost, staff time allocation, and patient volume.
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Last Updated: February 25, 2019Webinar on projecting expenses for the community palliative care service.
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Cost of Services Tool (COST) User Guide
Last Updated: February 3, 2019Using the COST worksheets to model community program costs based on service assumptions. Excerpted from the CAPC Payment Accelerator, 2017.
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COST Workbook Example
Last Updated: February 3, 2019Sample workbook for modeling detailed service assumptions to generate program cost estimates. Excerpted from the CAPC Payment Accelerator, 2017.
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Cost of Services Tool (COST) Workbook Blank
Last Updated: February 3, 2019Customizable workbook for community-based programs to create cost projections. Excerpted from the CAPC Payment Accelerator, 2017.
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Pricing Development Guide For Palliative Care Providers Seeking Payment Contracts
Last Updated: February 3, 2019Define program prices and determine the acceptability of prices offered by payers. Excerpted from the CAPC Payment Accelerator, reviewed 2018.
members loginBusiness Planning and Budgeting
Translate service, staffing, cost, and billing revenue projections into a budget and business plan.
Building the Business Plan for Your Hospital Program
Last Updated: January 15, 2015Building a budget and a business plan for the inpatient program. Includes business planning tools.
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Hospital Palliative Care Business Plan Outline
Last Updated: January 29, 2019Training and a template for creating a business plan for your inpatient service. Center to Advance Palliative Care, 2015.
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Budget Model Worksheet
Last Updated: January 29, 2019Annotated budget worksheet that can be customized based on your program's patient, service, and staffing assumptions. Center to Advance Palliative Care, 2015.
members loginBuilding the Business Plan for Community-Based Palliative Care
Last Updated: November 12, 2015Building a budget and a business plan for the community-based program. Includes business planning tools.
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Community Palliative Care Business Plan Checklist
Last Updated: January 29, 2019Organize working assumptions about patient population, service model, and program staffing. Center to Advance Palliative Care, 2017.
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Community Palliative Care Scenario Builder: Demonstrating the Interaction of Variables in Costs and Capacity
Last Updated: January 29, 2019Use this tool to organize your thinking on the budget and business plan, and to identify gaps that require more research.
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Developing a Business Plan for Your Community-Based Program
Last Updated: January 29, 2019Guide to creating a community-based program business plan, including making the business case, defining value, and creating a work plan and budget.
members loginBusiness Plans for Community-Based Palliative Care: Principles to Guide Development of a Sustainable Program
Last Updated: February 25, 2019Presentation on business planning fundamentals.
watchBusiness Planning: Building Blocks of Community-Based Palliative Care Programs
Q&A about business planning for the new or growing community-based palliative care program, including understanding barriers and critical components for success.
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Billing Revenue Estimator for Services Provided in the Community
Last Updated: January 29, 2019Overview of CMS rates for community-based services and template to estimate revenue.
members loginMaximizing Productivity and Operating Efficiently
Meet quality standards while optimizing efficiency in order to meet the assumptions you have laid out in your business plan.
Maximizing Palliative Care Program Efficiency
Last Updated: March 4, 2019Improving productivity and efficiency to ensure team health and operating within budget.
viewContracting with Financial Partners
Guidance for contracting with health plans or other entities to secure funding your palliative care program.
Tips for Hiring Lawyers and Actuaries-Financial Advisors
Last Updated: February 3, 2019Key roles when developing financial partnerships, including how to find and select these consultants.
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Simple Rules for Making Alliances Work
Last Updated: February 3, 2019Harvard Business Review on developing and nurturing business relationships.
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Advice from 2017 Accelerator Alumni
Last Updated: February 3, 2019Lessons from Accelerator alumni on building financial relationships with health plans.
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Key Contract Provisions for Payment Contracts
Last Updated: February 3, 2019Key contract clauses including term, termination, quality reporting parameters, and risk corridors.
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Regulatory and Licensure Considerations
Last Updated: February 3, 2019Legal obstacles impeding access to palliative care.
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Contract Protections for Downside Risk
Last Updated: February 3, 2019Understanding contract protections for downside risk, such as exclusion of outliers and stop-loss provisions.
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Template MOU
Last Updated: February 3, 2019The "Memorandum of Understanding" or MOU is a brief document that outlines mutual responsibilities. Follow this outline to draft an MOU (must be reviewed by legal counsel).
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Contracting Workflow for Providers
Last Updated: February 3, 2019Capabilities, processes, and functions (such as marketing or finance) that must be demonstrated to secure payment.
members loginFaculty
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Diane E. Meier, MD, FACP, FAAHPM
Director, Center to Advance Palliative Care
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Lynn Hill Spragens, MBA
President and CEO
Spragens & Associates, LLC -
Allison Silvers, MBA
Vice President, Payment and Policy
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Torrie Fields, MPH
Senior Program Manager
Blue Shield of California -
Jackie Selby, JD
Member
Epstein Becker Green
Related Toolkits See all 25 toolkits
Tools to make the case for palliative care resources and financial partnerships, including: the palliative care evidence base, and downloadable tools for presenting the case.
Includes 28 resources:
- Palliative Care Impact
- Tools for Making the Case to Stakeholders
- Measurement
- Successful Care Models
- For Patients and Families
Toolkit with billing and coding best practices for palliative care services delivered in the hospital or the community.
Includes 51 resources:
- Foundational Principles of Palliative Care Billing
- Evaluation and Management (E/M)
- Prolonged Services
- Advance Care Planning (ACP)
- Chronic Care Management and Complex Chronic Care Management
- Care Plan Oversight (CPO)
- Transitional Care Management (TCM)
- Billing for Palliative Care in the Intensive Care Unit (ICU) and the Emergency Department (ED)
Tools to develop financial partnerships including: making the case, contracting considerations, and how to use legal and financial advisers.
Includes 35 resources:
- Estimating Costs and Designing an Efficient Program
- Business Partnerships
- Target Measures
- Managing Populations
- Contracting and Legal Issues