Using this presentation

1. Example of a PowerPoint Presentation to Hospital Administration for a proposed Palliative Care ProgramPrepared byCenter to Advance Palliative Carewww.capc.org

2. Using this presentation The material in this presentation is organized in a Business Plan format, for programs ready to present a complete business plan. Alternatively, for programs that are first trying to get buy-in to develop a business plan, slides 18-29 can be used to outline the rationale for a palliative care program.

3. Palliative Care Program Proposal (Insert Name) Hospital

4. Palliative Care Planning Committee List Names and Titles/Departments

5. Presentation Agenda Summary of the proposal Data that a problem exists at our hospital Proposed operational plan Marketing plan Budget

6. 1. Summary Proposal A. We propose to start a Palliative Care Program by (insert date) to include the following features Inpatient multi-disciplinary consultation service Updating hospital policies/procedures/standards to support best practice in palliative care A system to track program impact on family satisfaction, ICU length of stay, and hospital cost

7. B. Program Goals Meet or exceed national palliative care standards Achieve Joint Commission Certificate in Palliative Care by (insert date) Be viewed as a community leader in palliative care clinical service and health professional education Reduce ICU Length of Stay Reduce hospital cost

8. 2. What is the problem? The planning committee has worked with hospital administration to collect data that provides a snapshot of the current state of palliative care at our hospital. This data will demonstrate that our patients, families, and staff believe that there is considerable opportunity for improving care.

9. Note The following slides provide examples of commonly used data points, substitute your own information.

10. Data Point #1: Patient Satisfaction 2007 Patient Satisfaction Data Compared to hospitals our size, we scored: Pain management: (insert) percentile Communication with the attending physician: (insert) percentile Coordination of discharge planning: (insert) percentile

11. Data Point #2 Dartmouth Atlas * Compared to our five leading competitors: We ranked (insert) in percentage of decedents admitted to the ICU during the hospitalization in which they died (insert percentage); range (insert range) We ranked (insert) in hospice enrollment http://www.dartmouthatlas.org/data_tools.shtm

12. Data Point #3 Cost/LOS In 2007, there were (insert) inpatient deaths, with an average length of stay (LOS) of (insert) days. (insert percentage) of deaths occurred in the ICU, with an average LOS of (insert) days. The Emergency Department was closed to potential ICU cases on (insert percentage) of days in 2007.

13. Data Point #4 Physician Survey A survey to staff physicians (N = insert) found: (insert)% indicated frustration in managing conflicts about end-of-life decisions with families (insert)% indicated concern about liability when prescribing opioids to seriously ill patients (insert)% indicated support for a palliative care consultation service.

14. Profitability analysis--Inpatient deaths # of Deaths = (insert number ofinpatient deaths) Total Cost = $(insert) Total Reimbursement = $(insert) Total Loss = $(insert)

15. What are our competitors doing? Among the (insert number) regional competitor hospitals: (insert number or names) have an active palliative care program including a nurse and physician with dedicated FTEs devoted to palliative care (Insert number of names) have formed palliative care planning committees

16. # of U.S. Hospital Palliative Care Programs 2000-2006

17. What are the national standards? National Quality Forum: 38 Preferred Practices in Hospice/Palliative Care (2006) Physician Board Certification Hospice/Palliative Medicine is recognized by American Board of Medical Specialties; First Exam in 2008 Nursing Board Certification APN, RN, CNA certification available

18. What is Palliative Care and how can it help meet our problems? Definition Care Model Cost Avoidance

19. A. Definition Palliative care is anInterdisciplinary specialty that aims to relieve suffering and improve quality of life for patients with advanced illness, and their families. It is provided simultaneously with all other appropriate medical treatment.

20. Palliative Care is … Pain and Symptom Control Goal setting Prognostication Psycho-Spiritual support Integration at start of a life threatening illness—not just in the final days of life.

21. NHWG; Adapted from work of the Canadian Palliative Care Association & Frank Ferris, MD PALLIATIVE CARE ACROSS THE DISEASE CONTINUUM Disease Modifying Therapy Curative, or restorative intent Death & Bereavement Palliative CareHospice

22. Relationship to Hospice Hospice is both a philosophy, and a health care reimbursement system Restrictions on eligibility (< 6 months prognosis) Restrictions on treatments (palliative intent and only treatments that are financially feasible). Palliative Care has no restrictions on eligibility or use of treatments. Hospice is a subset of Palliative Care, for patients who meet the hospice eligibility requirements.

23. B. Care Model The predominant US model is a consultation service, similar to any other hospital consult service (1) Physician-order required for consultation (2) Interdisciplinary care team: MD/APN/Others Many hospitals open a dedicated or swing bed inpatient unit once the consult service is well established. 2. Established hospitals often move to development of automatic triggers for consultation based on patient or disease criteria.

24. Common Reasons for Consultation Manage complex pain/symptom problems Establish patient-centered goals of care Support physicians in complex decision making (e.g. tube feeding, withdrawal of dialysis) Support for family/patient in distress Case manage the transition process across care settings (e.g. hospital to home hospice)

25. How Does Palliative Care Improve Care? Care of seriously ill patients is often poorly coordinated: Multiple consulting physicians Poor communication with patient/family Lack of realistic prognostic information Lack of clear medical goals Poor pain/symptom management

26. How does Palliative Care Improve Care? Primary Benefits Helps doctors, patients and families set realistic goals Improves communication between patient/family and health care providers Improves pain/symptom management Improves patient/family satisfaction Secondary Benefits Reduce ICU length of stay Reduce hospital cost (Cost Avoidance)

27. How does Palliative Care reduce cost? For patients with fixed/DRG payment (e.g. Medicare), hospital costs often exceeds reimbursement due to long LOS with high resource utilization. By establishing goals of care, reducing symptom burden, and supporting physicians through difficult decisions, direct costs and ICU LOS will be reduced.

29. Cost Avoidance A useful estimate is that for every palliative care consultation, a hospital can expect to reduce poorly reimbursed cost by ~$1400/case. (1) Hospitals use this cost avoidance to fund the key staff who provide Palliative Care consultations. 1. Assumes a fully staffed palliative care program.

30. NOTE: The following slides provide examples of a generic consult service. Substitute your own information.

31. 3. Operational Plan 1. Consultation Service 8 am-5 pm operation during first two years, then 24/7 Physician initiated consultations 2. Patient Volume Projections Year 1: (insert) consults Year 2: (insert) consults Year 3: (insert) Consults

32. Operational Plan 3. Staffing Advance Practice Nurse (insert FTE) Physician (insert FTE) Mental Health 1 (insert FTE) Program Director (insert FTE) Secretarial support (insert FTE) 4. Oversight Palliative Care Operations Committee; reportable through Hospital Medicine service line. 1. Social worker, chaplain, psychologist, psychiatrist

33. Palliative Care Operations Committee Membership Palliative Care clinical team Hospital administrator Discharge Planning Social Service Quality improvement Pharmacy Dietary

34. Palliative Care Operations Committee Responsibilities Program metrics Quality Improvement Review/update policies/procedures Staff education Community outreach Interface with hospital philanthropy

35. Program evaluation metrics Consultation demographics Days to consult, days to discharge Utilization across hospital service lines 2. Cost/LOS Pre and post consultation direct cost ICU Length of Stay and Cost: DRG matched patients with and without consultation

36. Customer Satisfaction Bereavement survey to families following death Referring physician survey: quality/timeliness of services

37. 4. Marketing Plan Medical Grand Rounds presentation Palliative Care Physician to meet with key physician staff (e.g. ICU and oncology staff) Palliative Care Nurse to meet with inpatient nursing unit directors, social workers, and discharge planners. Distribution of Palliative Care Fast Facts to hospital staff physicians Poster display outside cafeteria Hospital Newsletter announcement

38. Financial Summary: Revenue/Cost Avoidance a) Expected Cost Avoidance $1400 X (insert expected first year number of consultations) = $(insert) b) Expected Billing Revenue * = $(insert ) c) Total = $(insert) * To calculate billing revenue, use the Billing Worksheet tool on the CAPC website (HYPERLINK)

39. 5. Financial Summary: Expenses Salary Support $(insert) Materials/Office Supplies $(insert) Staff education $(insert) Total Expenses $(insert) Year 1 Cost Avoidance + Billings = $(insert) Expected Balance $(insert)

40. Philanthropy To further reduce hospital funding costs for the palliative care program, a comprehensive effort at seeking philanthropic support is recommended.

41. Summary The proposed Palliative Care Program will meet the needs of our patients, families and staff meet national quality standards reduce hospital cost and ICU LOS help solidify our community reputation as a hospital of excellence. Thank You