Guest blogger:
Kari Haberman, PT, DPT, Director of Palliative Care, Paradigm Health, Indianapolis Indiana

As you consider a palliative care program, existing resources may define your initial structure. If your organization is a home health or hospice agency, you may have existing staff with an interest in gaining skills in palliative care. It’s possible to start your palliative care offering as a bridge to your hospice program. Home health visits that include goals of care conversations are the building blocks of a trusting relationship that can make transitions of care easier for patients and their families.

As you budget for the program, define whether it will be complimentary to your existing hospice or home health program.

Answer these questions:
Can your current back-office team support a new line of service?
Can you current EMR work for palliative care or will you need to upgrade?
Is your brand awareness and ability to market and access referrals sufficient

If instead, you are considering a stand-alone program, evaluate potential visit density. Assess whether you can see enough patients each day to make the program viable. If not, can telehealth bolster the number of visits?

As you plan staffing, include nurse practitioners and social workers, a collaborative/consulting physician, and community resources in your staffing structure. It can be challenging to find NPs with palliative experience, so look for individuals who are eager to learn and share characteristics like: the ability to build strong relationships, excellent communication skills (which means listening as well as speaking), a high degree of self-motivation, and a commitment to collaboration. Your LCSW staff should have a good grasp of available resources. They are likely to provide referrals to clergy and other community-based resources for their client/patients.

Your intake process should include the order for palliative care, the name and contact for the patient’s physician and care team specialists, documentation of the symptoms to be managed, and advanced directive, and consents.

Initial document should include a full assessment, list of problems, plan of care, collaboration with the primary care physician or ordering specialist, medications, and the charge slip. Ongoing documentation should include patient and family communication, physician/care team collaboration, and referrals for additional services or providers.

Billing will reference time-based CPT codes with modifiers for additional time and notes on the place of service which can range from telehealth to residential or inpatient settings.

Finally, use data to evaluate and sustain your program. Include patient-related KPIs plus productivity of clinicians, main referral sources, and most common payor.

Palliative care is a personally rewarding professional field that can expand the continuum of care services provided in your community.

Palliative is NOT hospice care, urgent care, or a replacement for primary care or home health. But it can be extra support for any or all of these by giving patients a medical language-fluent practitioner as a support. Palliative Care practitioners develop a special relationship with their patients and often act a liaison with primary and specialty care teams in support of the patient and their family. Chronic illness makes us vulnerable and that experience can work against our goals. Having an advocate on your side makes a huge difference.