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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