Top 5 Keys to Success with Palliative Care
Is your palliative care program a loss leader or a thriving business that diversifies your service lines? In this blog, we’re breaking down the five steps to defining your palliative care strategy so you can make a bigger impact and stand apart from the crowd.
For years, hospices have provided palliative care services without necessarily getting reimbursed for it. They have seen the gap in care and have stepped up to serve these patients who desperately need support with many chronic and debilitating conditions because they are experts at it. By providing these services, hospices are able to build history with the patient, develop trust, and demonstrate their high standards, giving the patient a true platform of care. Palliative care can be the natural predecessor to hospice care, so when a patient’s prognosis changes, the patient is in good hands knowing they can safely transition into a new level of service with a provider they know and trust. This then creates a seamless transition of care and a positive experience for the patient and family.
With the ever-evolving changes in hospice criteria and limiting admission criteria, it becomes a growing cost center to provide diverse programs. It begs the question: can hospices sustain a cost centered model of care? Or is it time to really look at making palliative care its own viable service line; if so, what does that even entail?
Here are the top five keys to success for creating a thriving palliative care program.
- Start with real intent
- Define your market strategy
- Define your staffing strategy
- Formulate your reimbursement strategy
- Build your program with a smart system behind it
Start with the real intent.
What is your overall business strategy? How does your palliative care service line fit? What is the expectation of your palliative care program? Are you expecting it to be a profit center or a cost center?
There are two types of focus:
- A cost center model in your existing hospice program
- A profit center that is independent of your hospice program
When you are building a program, one that is well-run can cover its costs along with a sustainable profit margin. It does not usually generate the same types of margins of a hospice, but it doesn’t have to be the loss leader like it has been for many hospices.
In a time where survival depends on diversification, realigning your palliative care intent to become a viable service line with its own revenue stream may prevent leakage in your business. This will allow you to reallocate cash flow to new programs or business development efforts that elevate your performance across the board.
Define your market strategy.
Is palliative care your only line of business, or how does it fit into your business strategy? What is your target market within your geographical area? Is it the same as your other service lines? Do you have a new market segment to promote this offering to? And how do you capture your existing market by educating them on the value of this service line?
Most providers have different marketing reps for their different lines of business. It has been proven by much trial and error over the years that while a marketer can promote a company, referral sources see you for one thing and remember you for what you are most prominent for in their mind. So, by having a focused marketing effort, with a defined target market, you will be more successful in growing your palliative care service line.
Spend some time to tactically define your existing market and what marketing efforts are needed there vs. your new potential market and how you will introduce the company and the value you provide. Allocate focused resources to marketing your palliative care program.
Define your staffing strategy.
How are you going to staff your palliative care program? To be a certified palliative care program, you must use staff that are independent from your hospice. Billable palliative care visits may be provided by physicians, nurse practitioners or licensed clinical social workers. What type of visits will you provide? Do staff know the proper billing codes to use for these visits? How will you coordinate with other providers to ensure you are not duplicating visit types for a patient?
It is critical to mitigate rejected claims and lost revenue by identifying your staff, defining your visit types and how you will bill for them. Having processes in place for how you will coordinate care with other providers is essential to a successful program.
Formulate your reimbursement strategy.
How are you planning to bill for palliative care visits? Will you capture documentation and billing codes in your EHR? Will you track reimbursable expenses or will you use other funds such as support from other business lines, foundation money or profits from other operations to cover palliative care as a business building effort for your hospice? Your program intent will drive the reimbursement model that you implement.
It can be difficult to educate staff around the complexities of palliative care billing. Many programs significantly under bill because of this. This is where using palliative care software that is thoughtfully designed to simplify visit types, time, and complexity for clinicians can make all the difference.
Build your program with a smart system behind it.
How do you plan to document for your palliative care visits? Do you have a system in place? How does this system talk to other systems that other service lines may use?
Will your program be accredited or certified by ACHC, Joint Commission or CHAP? Knowing their requirements will influence your business process and how and what you track in your software. For example, multi-disciplinary services that are billable are required for accreditation. Not all systems do this. Some only send out super bills and do not have the ability to document IDT/IDG meetings or other certification requirements. So, it’s important to understand the business processes you will have to follow and have a plan for how you will efficiently manage those in your system.
It is anticipated that Medicare will require programs to be accredited or follow some type of standards. So, by implementing strong software solutions on the front end, you be well positioned to not only scale with efficiency, but to be adaptable as regulations evolve.
Summary
The thought of taking your palliative care program from a loss leader to a thriving service line may sound daunting. However, by taking it one piece at a time and defining your intent, market strategy, staffing, reimbursement strategy and what software you will use, it can be the very thing that sets your hospice apart and allows you to reallocate cash flow to business building efforts that generate an even higher return. It also positions your hospice to move up the care continuum and provide deeper and more meaningful levels of care to the most ailing part of the population.
Curantis Solutions can help.
Curantis Solutions is the first palliative care software to fully integrate the advanced care planning documentation practices with the visit complexity, time, CPT codes and KPIs of palliative care to create a comprehensive solution for elevating the performance of a palliative care program. We’re setting the standard for high performing palliative care programs across the country!
