Funding 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, 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

The basics of health care payment.

CAPC Payment Primer- What to Know about Payment for Palliative Care Delivery

Last Updated: March 5, 2019

This 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.

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Understanding Palliative Care Payment Opportunities with CAPC's Payment Primer

Last Updated: February 8, 2019

An overview of payment models, health plans, and key terms for providers to understand when partnering with payers.

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Payment Glossary

Last Updated: March 5, 2019

Defines key terms in payment vocabulary. Center to Advance Palliative Care, 2017.

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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, 2019

Toolkit 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, 2019

Recruitment, 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, 2019

A presentation on how to request philanthropic funding. Center to Advance Palliative Care, 2018.

Tools for Making the Case

Last Updated: February 19, 2019

Guidance 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, 2019

List of payment models that have been used for community-based palliative care services, along with their pros and cons for providers.

Alternative Payment for Palliative Care: Getting from Here to There Webinar Recording

Last Updated: February 6, 2019

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Potential Payer Partnerships

Last Updated: February 3, 2019

Overview of the range of potential financial partners for community palliative care.

Value-Based Payment: Building a Financially Sustainable Palliative Care Service

Last Updated: March 4, 2019

Tools to develop financial partnerships including: making the case, contracting considerations, and how to use legal and financial advisers.

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A sustainable business plan depends upon making realistic assumptions about patient volume and staff capacity.

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Hospital Patient Volumes and Characteristics Worksheet

Last Updated: January 29, 2019

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

Last Updated: January 29, 2019

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

Last Updated: January 29, 2019

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

Last Updated: January 29, 2019

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

Last Updated: February 3, 2019

Estimating patient volume by referral type, time per encounter, and staff capacity. Center to Advance Palliative Care, 2018.

Using service volume and staffing estimates to project program costs.

Hospital Impact Calculator

Last Updated: March 1, 2019

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

Last Updated: May 6, 2019

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

Last Updated: January 29, 2019

Model your assumptions about costs based on the variables of staff cost, staff time allocation, and patient volume.

Deep Dive into Understanding Costs

Last Updated: February 25, 2019

Webinar on projecting expenses for the community palliative care service.

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Cost of Services Tool (COST) User Guide

Last Updated: February 3, 2019

Using 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, 2019

Sample 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, 2019

Customizable 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, 2019

Define program prices and determine the acceptability of prices offered by payers. Excerpted from the CAPC Payment Accelerator, reviewed 2018.

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, 2015

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

Last Updated: January 29, 2019

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

Last Updated: January 29, 2019

Annotated budget worksheet that can be customized based on your program's patient, service, and staffing assumptions. Center to Advance Palliative Care, 2015.

Building the Business Plan for Community-Based Palliative Care

Last Updated: November 12, 2015

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

Last Updated: January 29, 2019

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

Last Updated: January 29, 2019

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

Last Updated: January 29, 2019

Guide to creating a community-based program business plan, including making the business case, defining value, and creating a work plan and budget.

Business Plans for Community-Based Palliative Care: Principles to Guide Development of a Sustainable Program

Last Updated: February 25, 2019

Presentation on business planning fundamentals.

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Business 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, 2019

Overview of CMS rates for community-based services and template to estimate revenue.

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, 2019

Improving productivity and efficiency to ensure team health and operating within budget.

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Guidance for contracting with health plans or other entities to secure funding your palliative care program.

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Tips for Hiring Lawyers and Actuaries-Financial Advisors

Last Updated: February 3, 2019

Key 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, 2019

Harvard Business Review on developing and nurturing business relationships.

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Advice from 2017 Accelerator Alumni

Last Updated: February 3, 2019

Lessons from Accelerator alumni on building financial relationships with health plans.

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Key Contract Provisions for Payment Contracts

Last Updated: February 3, 2019

Key contract clauses including term, termination, quality reporting parameters, and risk corridors.

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Regulatory and Licensure Considerations

Last Updated: February 3, 2019

Legal obstacles impeding access to palliative care.

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Contract Protections for Downside Risk

Last Updated: February 3, 2019

Understanding contract protections for downside risk, such as exclusion of outliers and stop-loss provisions.

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Template MOU

Last Updated: February 3, 2019

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

Last Updated: February 3, 2019

Capabilities, processes, and functions (such as marketing or finance) that must be demonstrated to secure payment.

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Sample Provider Education Document

Last Updated: May 6, 2019

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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