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?

? ? ?

? ?

For references and additional invaluable resources:

The IPAL Project: IPAL-OP located at

www.capc.org