program development for outpatient palliative care monica malec, md clinical director of palliative...

Program Development for

Outpatient Palliative CareMonica Malec, MD

Clinical Director of Palliative Medicine Services

University of Chicago

Why?

• Part of overall strategic plan

• Continuity of care

• Education

• Quality Improvement

Who?

• Determine the patient population• Specific disease• Specific symptom• Specific services

Where?

Embedded

• Within existing clinic

• Focused patient population

• Cost supported by host clinic

Co-located

• Shared space

• Independence to determine patients population

• Shared cost with host clinic

Stand-alone

• Unique clinic

• Independence to determine patient population

• Full responsibility for costs

How?

• Patient scheduling• Linked vs Unlinked visits

• Billing

• Prior authorizations

• Prescription refills

• Follow up phone calls

• After hours calls

Projected Visits

• Determine template• New Patients

• 60 minutes

• Return patients• 30 minutes

½ day = 2 new patients + 4 returns

Projected visits

• For each ½ day • Assuming 44 weeks of clinic

• 88 new patients• 176 returns

• For 1 FTE• Assuming 8 clinics/week

• 704 new patients• 1408 returns

Projected Billing

• Revenue generated will not cover cost

• Will be dependent on payer mix

• Typically about 50%

Projected RVUs

CPT code RVU

Initial visit 99204 2.43

99205 3.17

Return 99214 1.50

99215 2.11

Consult 99244 3.02

99245 3.77

Measuring Success

• Number patients served

• Timely referrals

• Improved symptoms

• Increased hospice referrals/LOS

• Decreased ER visits/admissions

• Improved patient satisfaction

University of Chicago

• Clinic embedded in Oncology

• Co-management model

• Started with single clinic in the Advanced Solid Tumor Clinic ( phase 1 clinic )

• Now 3 clinics /week• Referrals from ASTC, head and neck, GI,GU, Lung,

MM, gyne-onc, breast• FY12 621 pt visits• FY13 663 pt visits• FY14 100 so far

Questions?

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For references and additional invaluable resources:

The IPAL Project: IPAL-OP located at

www.capc.org