PCLC Curriculum Module 8: Program Implementation The Palliative Care Business Plan …

1. PCLC CurriculumModule 8: Program Implementation The Palliative Care Business Plan…

2. Acknowledgements Adapted from content created by… • Lori Yosick, LISW-S, CHPCA, Executive Director of Mount Carmel Health System, Columbus, Ohio, Palliative Care Leadership Center Slide 2 of 27

3. Business Plan Basics Or: Yes, You Can! Developing a Plan to Explain How Palliative Care Will Improve Hospital Performance Slide 3 of 27

4. Characteristics of Best Plans • Tells the Story of Who, What, When, Where, Why & How • Concrete in setting forth goals and responsibilities • Assign tasks, set milestones & deadlines for tracking implementation • Practical: includes 10 parts implementation for every one part strategy. Slide 4 of 27

5. What Are You Trying To Do? Describe activities: Choose at least 4 • Decrease LOS in ICU • Improve communication around goals of care • Improve symptom management for patients with serious illness • Improve transition to nursing facility, home care or hospice • Decrease fragmentation of care • Reduce unwanted, non-beneficial care Slide 5 of 27

6. Clearly Establish Why Hospital Based Palliative Care Is Important 1. Clinical imperative 2. Concordance with patient and family preferences 3. Demographic imperative-- meets the needs of growing aging and chronically ill population 4. Educational imperative 5. Fiscal imperative-- cost avoidance, improved hospital capacity, revenue generation. Slide 6 of 27

7. Discuss Benefit for Hospice: Realities and Survival Strategies • Earlier referral • Appropriate Hospital Discharge Plan • Access to patients during hospitalization to plan admission • Increase LOS to provide care and spread costs • Advance Care Planning process in place • Adherence to formulary Slide 7 of 27

8. Delineate Clinical Goals • Accessible, expert Advance Care Planning • Assessment of hospitalized patients’ needs for optimal pain/symptom management • Provision of Interdisciplinary palliation for patients and families within explicit time frames • If part of your program: Transfer of patients from ICU and ED to Acute Palliative Care Unit; from APCU to Hospice Slide 8 of 27

9. What is a Business Plan?Writing a Story • Do this with the team • Why: what is the problem • What: will our service provide? • Where: hospital-wide consult team • When (24/7, starting when…) • Who (staffing) • How? • How much? Slide 9 of 27

10. Why do the plan? • Organize thoughts/ formalizes request • Clearly links resource needs to impact • Creates momentum/is proactive • You will not get funding without asking • Chance to compete against other resource initiatives • Road Map – Ensures smoother start up, faster implementation Slide 10 of 27

11. Planning is a PROCESS • Vehicle, not a document • Must be done and redone and redone • Not a static task to be done at the beginning and gotten through • Get help from senior leadership and finance people • Get an example of a successful business plan within own institution to see what worked Slide 11 of 27

12. Parts of the Plan • Executive summary • Institutional analysis/market review • Make it real for your institution • Clinical, financial & staff satisfaction data • Competing local/regional initiatives • Operational plan for implementation • Marketing plan • Financial/budget summary • Appendices • Data and interviews (thorough work done to make the case) • Letters of support from stakeholders Slide 12 of 27

13. Executive Summary • Big-picture program objectives • Context: why now, why here? • What is the broken problem to be fixed? • Why is it in the institution’s best interest to fix the problem • Use national “Thou Shalts” to help build case • How your proposed plan will fix the problem • Key program features • Funding requirements • Expected impact and measurement metrics Slide 13 of 27

14. Clarify Important Definitions Palliative Care: Interdisciplinary care for seriously ill patient with unpredictable prognosis during acute hospitalization; spiritual/emotional support for patient/family; concurrently preparing for improvement or decline/death; compatible with other treatments Hospice Care: Interdisciplinary care for dying patient with predictable prognosis; also for family– spiritual, emotional support--primarily in home setting, includes bereavement support Slide 14 of 27

15. Operational Plan • Policies and procedures • Space and equipment • Integration with existing local/regional programs • Pain service • Ethics consultation service • Discharge planning/case management • Community outreach initiatives (advance care planning) • Evaluation metrics and plans Slide 15 of 27

16. Describe Routine Processes • Identify the team (also RT, RPh, Dietitian) • Daily team rounds, IDT conferences • Palliative Consultation- physician, nurse clinician roles in coordination, mentoring • Intensive pain/symptom management • Hospice interface • IDT education, competency development • Process for data collection Slide 16 of 27

17. Differentiate Types of Patientsto be Served Patients with exacerbation of chronic illness who choose palliative life-extending treatment Patients receiving disease-directed treatment who may benefit from palliation of sx arising from disease or treatment Patients with serious, life-limiting illnesses for whom hospitalization often segues to hospice Patients with acute event such as CVA Slide 17 of 27

18. Marketing Plan • The Sales pitch • Creating the “win-win” • Targeting the message to the specific audience • Include resources needed in plan • Planned approach to market to key stakeholders Slide 18 of 27

19. Financial/Budget Summary • Multi-year budget • Revenue • Professional billing, hospital support, philanthropy, grants, contracts • Expenses: usually direct • PC staff salaries/replacement time, staff education, travel, marketing, office supplies, equipment • Cost avoidance expectation: Use national data initially Slide 19 of 27

20. Financial Plan/Budget • Consult Service • Billing Revenue • Other Revenue • Personnel/Benefit Costs • Purchased Services • Mileage • Other • Hospital Cost Savings • New Hospital Revenue • Philanthropy Slide 20 of 27

21. Appendix • Models • Charts (organizational table) • Biographies • Detailed Tables or Financial Data Slide 21 of 27

22. More Supportive Information • Discuss Current State vs Desired State • Identify Stakeholders: consider Palliative Care Advisory Committee • Population and demographics • Hospice information • % of market not being served by hospice • Physician specialties • Palliative care physicians in the area- or MDs who consider themselves also expert in this area Slide 22 of 27

23. Analyze Hospital Datato Project Volumes • 5% Hospital Admissions annually • Top 20 DRGs resulting in death • Readmission rates within 6 months • Number of SNF patients entering ED • ICU deaths post 5 day LOS Slide 23 of 27

24. Business Plan Components • Customers • Patients/families • Clinicians • Organizations (including schools, employers) • Growth projections • Staff, visits/consults, subspecialty penetration • Include assumptions • Revenue projections • Include assumptions • Space needs • IS needs • Capital estimate Slide 24 of 27

25. More Plan Components • Competitors: opportunities/threats • Local, regional, national • Other risks • Reduced demand, limited resources, provider unavailability, other? • Alternatives considered • Key benefits • Clinical quality, market, financial, mission-based • Timeline • Project team Slide 25 of 27

26. Develop a Development Plan • Clinical reimbursement will not suffice • Grants, philanthropy • Team excitement – “The right thing to do” • Philanthropic support valid income stream • Close relationship of development team with clinical service • Frequent presence of physician, team members • Invite as member of Advisory Committee • Specific fundraising for specific causes • Staying on the radar screen Slide 26 of 27

27. TOOLS • www.capc.org : templates for Business Plans, including PowerPoint templates • Evidence-base data: • SUPPORT STUDY • Dartmouth Atlas • National Consensus Project • CAPC Benchmark Data Slide 27 of 27