Financing a Palliative Care Program
Last Reviewed: March 4, 2019
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.
Payment Quick Tips: Understanding Medicare, Medicaid, and Commercial Insurance
US health insurance and what it means for palliative care. Center to Advance Palliative Care, 2019.
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Payment Quick Tips: Value-Based Payment Introduction
Introduction to value-based payment and its implications for palliative care. Center to Advance Palliative Care, 2019.
members loginPayment Glossary
Defines 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
Toolkit with billing and coding best practices for palliative care services delivered in the hospital or the community.
viewTools for Making the Case
Guidance on making the case to organization leaders to secure budget for program startup and program operations.
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Philanthropy Strategies: Creating a Palliative Care Advisory Board
Recruitment, sample advisory board roles and responsibilities, and fundraising planning. Icahn School of Medicine at Mount Sinai, 2018.
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Philanthropy Strategies
A presentation on how to request philanthropic funding. Center to Advance Palliative Care, 2018.
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Payment Arrangement Options
List of payment models that have been used for community-based palliative care services, along with their pros and cons for providers.
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Quick Tips: Financing Your Community- Based Palliative Care Program
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.
members loginAlternative Payment for Palliative Care: Getting from Here to There Webinar Recording
Potential Payer Partnerships
Overview of the range of potential financial partners for community palliative care.
members loginValue-Based Payment: Building a Financially Sustainable Palliative Care Service
Tools to develop financial partnerships including: making the case, contracting considerations, and how to use legal and financial advisers.
viewSustainability Strategies for Community-Based Palliative Care
Financial blueprint for supporting rural services. Stratis Health.
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
Estimate 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
Project 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
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.
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Community Palliative Care: Estimating per Provider Visit Capacity
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.
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Home-Based Palliative Care: Pricing
Estimating 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
The 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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Community Palliative Care: Estimating Average Time/Visit to Determine Capacity
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.
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Template for Estimating Staff Costs for a Visit and a Patient
Model your assumptions about costs based on the variables of staff cost, staff time allocation, and patient volume.
members loginDeep Dive into Understanding Costs
Webinar on projecting expenses for the community palliative care service.
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Financial Analysis and Budgeting Tool for Community-Based Palliative Care
Customizable workbook for community-based programs to create cost projections and key financial stats. Center to Advance Palliative Care, 2019.
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Understanding Costs and Prices: Companion Guide for Financial Analysis and Budgeting Tool
Qualitative explanation of budgeting and finding opportunities for cost-efficiency. Center to Advance Palliative Care, 2019.
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Pricing Development Guide For Palliative Care Providers Seeking Payment Contracts
Define 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
Building a budget and a business plan for the inpatient program. Includes business planning tools.
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Hospital Palliative Care Business Plan Outline
Training 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
Annotated 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
Building 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
Organize 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
Use 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
Guide 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
Presentation on business planning fundamentals.
watchBusiness Planning: Building Blocks of Community-Based Palliative Care Programs
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.
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Billing Revenue Estimator for Services Provided in the Community
Overview 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
Improving 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.
Payment Quick Tips: Payment Partnerships
Introduction to building partnerships that can financially support palliative care programs. Center to Advance Palliative Care, 2019.
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Payment Quick Tips: Value-Based Payment Capabilities
Monograph outlining the leadership and operational competencies that palliative care teams need to succeed under value-based payment. Center to Advance Palliative Care, 2019.
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Tips for Hiring Lawyers and Actuaries-Financial Advisors
Key roles when developing financial partnerships, including how to find and select these consultants.
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Simple Rules for Making Alliances Work
Harvard Business Review on developing and nurturing business relationships.
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Advice from 2017 Accelerator Alumni
Lessons from Accelerator alumni on building financial relationships with health plans.
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Key Contract Provisions for Payment Contracts
Key contract clauses including term, termination, quality reporting parameters, and risk corridors.
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Regulatory and Licensure Considerations
Legal obstacles impeding access to palliative care.
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Contract Protections for Downside Risk
Understanding contract protections for downside risk, such as exclusion of outliers and stop-loss provisions.
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Template MOU
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).
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Contracting Workflow for Providers
Capabilities, processes, and functions (such as marketing or finance) that must be demonstrated to secure payment.
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Sample Provider Education Document
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.
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Related Toolkits See all 30 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 61 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)
- Relative Value Units (RVUs)