Donna W. Stevens, BS, Program Director, OACIS/Palliative Medicine
Lehigh Valley Health Network
Brynn Bowman, MPA, Vice President of Education
Center to Advance Palliative Care
We are working in interesting times.
Whether your palliative care program sits within a health system, a clinician group, a hospice or a home health agency, you are almost certainly straddling the fee-for-service and value-based worlds. There is a good chance that your program funding comes from multiple sources—each with its own financial stakeholders and service requirements. Relief of suffering for seriously ill patients is the north star, but the context for our work is changing rapidly and very much contingent upon the characteristics of your particular organization.
When the health care policy and payment ecosystem is uncertain, health care organizations are prone to retrenchment. Under constant financial pressure, the attention of too many organizational leaders tends to focus on money-making specialties and interventions. This means the more nuanced value propositions—of which palliative care is one—may come under the budgetary microscope.
In this article, we offer suggestions about how to get off the chopping block when your organization is thinking conservatively and looking to cut costs.
Remember that not all financial value is fee-for-service revenue.
Patient experience (CAHPS) scores, 30 day readmission rates, hospital mortality, cost per Medicare beneficiary—these measures are all part of how hospitals get ranked and paid on the publicly available Hospital Compare. Take a look at your own hospital’s ranking in comparison to other local hospitals and health systems. Palliative care has been shown to influence each of these metrics (and in fact, not having the essential palliative care skill of expert communication has been found to be the leading indicator of hospital readmissions). Palliative care therefore impacts the bottom line for virtually any financial stakeholder of your program. Help your stakeholders connect the dots between the work you do and the numbers they care about.
Not having the essential palliative care skill of expert communication has been found to be the leading indicator of hospital readmissions.
Remind stakeholders of “unseen” cost savings.
A strong body of research shows that both hospital-based and community-based palliative care programs help organizations avoid unnecessary costs. While avoided costs do not show up in the immediate profit-and-loss statement, it’s ‘penny wise and pound foolish’ to ignore them. Recognition of the impact of palliative care on avoidable hospital costs (and quality) is the reason that 75% of US hospitals with more than 50 beds now report the presence of a palliative care team. Hospital-based programs can use the CAPC Impact Calculator to estimate their program’s cost savings, while home-based programs can work with the ROI Calculator*.
Consider who would miss you if you were gone.
If you’ve been doing good work, you have made someone’s life easier—whether by helping patients, helping your colleagues help their patients, delivering on Medicare hospital star ratings and USNWR rankings, or saving your organization time and money. Tell the story of what will happen to your colleagues, your readmissions, your most vulnerable patients, if you are no longer able to help.
Illustrate with a personal story.
Without your services, people with serious illness and their families will suffer. Use a story about a particular patient to highlight what can happen without your program (particularly in community settings where there may be no safety net) and how things changed once palliative care got involved. This can go a long way toward illuminating the human costs of shrinking or cutting palliative care services.
It’s not 2005 anymore. The best provider organizations have palliative care.
Reputation cost means something to your leadership. Your program’s impact is no doubt bolstering market reputation, which is key to retaining patients and would suffer without your services. Make sure your stakeholders know that 100% of top-ranked USNWR adult and children’s hospitals are providing palliative care services. In recognition of their essential contribution to quality, The Joint Commission and other accrediting bodies offer quality certification for palliative care programs. U.S. News and World Report (page 21) gives points for presence of hospital/health system palliative care programs in every one of their specialty rankings (cancer, cardiology, diabetes, ENT, GI, geriatrics, gynecology, nephrology, neurology, orthopedics, and urology). If you are working in a hospital, use CAPC’s State Report Cards to demonstrate the extent of palliative care available through hospitals in your state. If your organization is a hospice, home health agency, long-term care facility, or clinician group, your palliative care program may be a key differentiator from the competition. See where your area stands.
Follow your needs assessment.
This is a CAPC blog—you didn’t think we would forget needs assessment, did you? This is the essential do-not-pass-go process by which you learn what your stakeholders care about—and then use that information to build the case for your services. Ask your stakeholders what metrics they care about, and then design your services and measure impact accordingly. CAPC has very comprehensive toolkits to guide both hospital* and community-based* programs through the needs assessment process.
Your financial stakeholders need to see that you are being a good steward of resources—and that means reaching the patients who can benefit most from your services, dosing program services according to patient need, and meeting your service expectations within a reasonable budget. To the extent that you are billing Part B, make sure you are using best practices* for palliative care to maximize appropriate billing.
Don’t start from scratch.
Use CAPC’s financial toolkits* on making the value case, understanding payment and costs, and billing, and our business planning for hospital* and community-based* programs. For in-depth training on how to work effectively with financial stakeholders, participate in the 2018 CAPC Payment Accelerator this November.