Financing a Palliative Care Program
Most 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, designing 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.
US health insurance and what it means for palliative care. Center to Advance Palliative Care, 2019.
Introduction to value-based payment and its implications for palliative care. Center to Advance Palliative Care, 2019.
Defines key terms in payment vocabulary. Center to Advance Palliative Care, 2017.
Ways 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.
Toolkit with billing and coding best practices for palliative care services delivered in the hospital or the community.
Guidance on making the case to organization leaders to secure budget for program startup and program operations.
Recruitment, sample advisory board roles and responsibilities, and fundraising planning. Icahn School of Medicine at Mount Sinai, 2018.
A presentation on how to request philanthropic funding. Center to Advance Palliative Care, 2018.
List of payment models that have been used for community-based palliative care services, along with their pros and cons for providers.
Navigating financing strategies for hospice-led palliative care including Medicare fee-for-service, payment contracts, organizational support and philanthropy. Center to Advance Palliative Care, 2019.
Overview of the range of potential financial partners for community palliative care.
Tools to develop financial partnerships including: making the case, contracting considerations, and how to use legal and financial advisers.
Financial blueprint for supporting rural services. Stratis Health.
Estimating Volume and Capacity
A sustainable business plan depends upon making realistic assumptions about patient volume and staff capacity.
Estimate patient volume using national comparative data from the CAPC National Palliative Care Registry. Center to Advance Palliative Care, 2015.
Project staffing FTE per discipline based on expected patient volumes. Center to Advance Palliative Care, 2015.
Template 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.
Uses 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.
Estimating patient volume by referral type, time per encounter, and staff capacity. Center to Advance Palliative Care, 2018.
Estimating Costs and Prices
Using service volume and staffing estimates to project program costs.
The Palliative Care Hospital Impact Calculator is designed to help you project overall cost savings for your inpatient palliative care consult service.
Template 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.
Model your assumptions about costs based on the variables of staff cost, staff time allocation, and patient volume.
Webinar on projecting expenses for the community palliative care service.
Customizable workbook for community-based programs to create cost projections and key financial stats. Center to Advance Palliative Care, 2019.
Qualitative explanation of budgeting and finding opportunities for cost-efficiency. Center to Advance Palliative Care, 2019.
Define program prices and determine the acceptability of prices offered by payers. Excerpted from the CAPC Payment Accelerator, reviewed 2018.
Business Planning and Budgeting
Translate service, staffing, cost, and billing revenue projections into a budget and business plan.
Building a budget and a business plan for the inpatient program. Includes business planning tools.
Training and a template for creating a business plan for your inpatient service. Center to Advance Palliative Care, 2015.
Annotated budget worksheet that can be customized based on your program's patient, service, and staffing assumptions. Center to Advance Palliative Care, 2015.
Building a budget and a business plan for the community-based program. Includes business planning tools.
Organize working assumptions about patient population, service model, and program staffing. Center to Advance Palliative Care, 2017.
Use this tool to organize your thinking on the budget and business plan, and to identify gaps that require more research.
Guide to creating a community-based program business plan, including making the business case, defining value, and creating a work plan and budget.
Presentation on business planning fundamentals.
In this Virtual Office Hour, ask about business planning for the new or growing community-based palliative care program, including understanding barriers and critical components for success.
Overview of CMS rates for community-based services and template to estimate revenue.
Maximizing Productivity and Operating Efficiently
Meet quality standards while optimizing efficiency in order to meet the assumptions you have laid out in your business plan.
Improving productivity and efficiency to ensure team health and operating within budget.
Contracting with Financial Partners
Guidance for contracting with health plans or other entities to secure funding your palliative care program.
Introduction to building partnerships that can financially support palliative care programs. Center to Advance Palliative Care, 2019.
Monograph outlining the leadership and operational competencies that palliative care teams need to succeed under value-based payment. Center to Advance Palliative Care, 2019.
Key roles when developing financial partnerships, including how to find and select these consultants.
Harvard Business Review on developing and nurturing business relationships.
Lessons from Accelerator alumni on building financial relationships with health plans.
Key contract clauses including term, termination, quality reporting parameters, and risk corridors.
Legal obstacles impeding access to palliative care.
Understanding contract protections for downside risk, such as exclusion of outliers and stop-loss provisions.
The "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).
Capabilities, processes, and functions (such as marketing or finance) that must be demonstrated to secure payment.
Developed by Blue Shield of California to ensure robust operations and quality within the palliative care provider network. Covers patient enrollment and disenrollment, billing and coding, and clinical care guidelines. Network management and legal can use this as a template to adapt to the needs of the organization.
