that your palliative care program improves value Thomas J. Smith, - PowerPoint PPT Presentation

How to show your administrators that your palliative care program improves value Thomas J. Smith, MD FACP FASCO FAAHPM Harry J. Duffey Family Professor of Palliative Medicine And Oncology Johns Hopkins Medical Institutions Baltimore, Maryland tsmit136@jhmi.edu

Join us for upcoming CAPC events Webinar: ➔ – A Population Health Approach to System-Wide Palliative Care: Tuesday, April 4, 2017 | 1:30-2:30 PM ET Virtual Office Hours: ➔ – Team Health and Wellness with Phil Higgins, PhD, LICSW • Thursday, March 23, 2017 at 12:00 pm ET – Palliative Care Models in the Home with Donna Stevens, BS • Thursday, March 23, 2017 at 1:00 pm ET – Palliative Care in Long Term Care Settings with Katy Lanz, DNP, ANP, GNP • Monday, March 27, 2017 at 12:00 pm ET – Measurement for Community-Based Palliative Care with J. Brian Cassel, PhD • Tuesday, March 28, 2017 at 11:00 am ET – Home Health Agencies Delivering Palliative Care in the Community with Bob Parker, DNP, RN, CENP, CHPN • Tuesday, March 28, 2017 at 2:00 pm ET ➔ CAPC Payment Accelerator: Supporting Palliative Care Programs in Value-Based Payment and Contracting – To learn more about this opportunity please visit https://www.capc.org/topics/payment/ or contact the Accelerator Coordinator with any questions at seema.satia@mssm.edu Visit www.capc.org/providers/webinars-and-virtual-office-hours / 2

How to show your administrators that your palliative care program improves value Thomas J. Smith, MD FACP FASCO FAAHPM Harry J. Duffey Family Professor of Palliative Medicine And Oncology Johns Hopkins Medical Institutions Baltimore, Maryland tsmit136@jhmi.edu

Disclosures I received $5100 to travel to Seoul Korea to lecture at an industry conference from 1. GEOMC, Inc. I have grant or research funding to Johns Hopkins University Sidney Kimmel 2. Comprehensive Cancer Center from – RO1 NCI: RCT of PC for Phase I patients (Ferrell, Smith) – RO1 National Institute of Nursing Research: HIV caregivers. (Knowlton PI) – PCORI: advance care planning for pancreas ca pts undergoing Whipple procedure (Aslakson PI) – Avon Foundation (randomized trial of Scrambler Therapy for chemo-induced peripheral neuropathy, CIPN) – Ho-Chiang Foundation (Scrambler Therapy for pain of pancreas cancer) – Lerner Foundation (fellowship in palliative medicine) – Milbank Foundation to assess impact of chaplains – Allegheny Health Foundation for placebo-controlled trial of topical 6% gabapentin for chemo induced neuropathy – Ho Chiang Foundation for teaching oncologists PC skills and tools 4

Disclosure of ABIM Service: Thomas Smith, MD  I am a current member of the Test-Writing Committee on Hospice and Palliative Medicine.  To protect the integrity of certification, ABIM enforces strict confidentiality and ownership of exam content.  As a current member of the Test-Writing Committee on Hospice and Palliative Medicine, I agree to keep exam information confidential.  As is true for any ABIM candidate who has taken an exam for certification, I have signed the Pledge of Honesty in which I have agreed to keep ABIM exam content confidential.  No exam questions will be disclosed in my presentation. 5

Objectives We can all take good care of people. 1. Proving that we contribute to the bottom line is key. 2. “Mission alignment.” Basics 3. – Who – What – Where – When – Why – Remember, to get these results you must do “full contact” PC 4. How to present the data. 6

We do understand And this is where you need the PCU volume, LOS, OP Financial Analysis people! visits, charges we dropped, right? Program Level Data Abstracted Type of Program Breakdown Referrals to Number of Average PCU Volumes Occupancy Charge JHU Net JHH Net JHU Variable JHU Variable JHH Variable JHH Variable JHH & JHU JHU Fixed JHU Fixed JHH Fixed JHH Fixed Total Cost JHH & JHU Net Margin by charge the program patient length of Rate Revenue Revenue Direct Cost Indirect Cost Direct Cost Indirect Cost Variable Net Direct Cost Indirect Cost Direct Cost Indirect Cost Profit (Loss) bucket (e.g., encounters stay Margin drug, lab, radiology) Palliative Direct (patients X N/A X X X X X X X X X X X X X X X X X X X directly transferred into the PCU follow hospital admission) Palliative Transfer (patients X X X X X X X X X X X X X X X X X X X X X transferred into the PCU from elsewhere in the hospital) X X X X X X X X X X X X X X X X X X X X X Pre-Transfers In (care that patients received before being transferred into PCU) X X X X X X X X X X X X X X X X X X X X Anticipated performance from the 2012 Business Plan X X X X X X X The professional fees for the hospital per department from January 2013-March 2014. Data includes invoice, charge, allocation of payment, controlled allocation of payment 7

“Easy! Just get your VIndCOST data!” JHH FY2015 Palliative Care Analysis “Huh?” Palliative Care & Pre-Transfer Summary Averages per Encounter Encounter Avg PC Days Avg PrePC Days Charge NetRev VDirCost VIndCost FDirCost FIndCost Total Cost VarNetMargin VNM % NetMargin NM % Palliative Direct 55 7.49 - $22,036 $20,473 $7,979 $2,626 $2,481 $8,226 $21,312 $9,868 48% ($839) -4% Palliative Transfer 104 6.07 - 12,891 11,287 5,347 1,809 1,554 5,667 14,377 4,131 37% (3,090) -27% Total Palliative Care 159 6.56 - 16,054 14,465 6,257 2,092 1,875 6,552 16,776 6,116 42% (2,311) -16% Pre Transfer 104 - 14 $59,409 $54,219 $21,709 $5,432 $6,829 $17,014 $50,984 $27,079 50% $3,235 6% Variance (Pre Transfer - Palliative Transfer) $46,518 $42,932 $16,361 $3,623 $5,275 $11,347 $36,606 $22,948 $6,325 Averages Per Day Encounter Total PC Days PrePC Days Charge NetRev VDirCost VIndCost FDirCost FIndCost Total Cost VarNetMargin VNM % NetMargin NM % Palliative Direct 55 412 - $2,942 $2,733 $1,065 $351 $331 $1,098 $2,845 $1,317 48% ($112) -4% Palliative Transfer 104 632 - 2,122 1,858 880 298 256 933 2,367 680 37% (509) -27% Total Palliative Care 159 1,044 - 2,446 2,203 953 319 286 998 2,555 932 42% (352) -16% Pre Transfer 104 - 1,232 $4,284 $3,910 $1,565 $392 $492 $1,227 $3,676 $1,953 50% $233 6% Variance (Pre Transfer - Palliative Transfer) $2,162 $2,052 $685 $94 $237 $294 $1,310 $1,273 $742 Total Palliative Care Encounter Total PC Days PrePC Days Charge NetRev VDirCost VIndCost FDirCost FIndCost Total Cost VarNetMargin VNM % NetMargin NM % Palliative Direct 55 412 - $1,211,956 $1,126,029 $438,837 $144,435 $136,473 $452,403 $1,172,147 $542,758 48% ($46,118) -4% Palliative Transfer 104 632 - 1,340,623 1,173,875 556,102 188,157 161,628 589,350 1,495,236 429,617 37% (321,361) -27% Total Palliative Care 159 1,044 - 2,552,579 2,299,904 994,938 332,591 298,101 1,041,753 2,667,383 972,375 42% (367,479) -16% Pre Transfer 104 - 1,442 $6,178,525 $ 5,638,794 $ 2,257,693 $ 564,918 $ 710,242 $ 1,769,454 $5,302,307 $ 2,816,183 50% $ 336,487 6% Variance (Pre Transfer - Palliative Transfer) $4,837,902 $4,464,919 $1,701,591 $376,761 $548,614 $1,180,104 $3,807,071 $2,386,566 $657,848 8

PCU saved $453 per person transferred. PC consults saved $2.7M. Pro fees added $370,000. Total $3.4 M Isenberg S, et al. J Oncol Practice 2017 9

The WHO - clinicians needed to see that we could help them Cancer patient symptoms are improved by PC consultation or transfer, with no change in mortality Memorial Symptom Assessment Scale, Condensed 30 pts with at least 2 consult days and symptoms > 0 Khatcheressian J, Coyne P, Smith T. Oncology September 2005 Pain 2.5 Nausea 2 Depression MSAS 0-3 1.5 Anxious 1 Shortness of Breath 0.5 Drowsy Appetite 0 1st day Comparison Fatigue/Activity Day 10

The WHO - administration needed to know we would not cost them too much Next, we showed that palliative care programs save money for hospitals and health systems… Daily charges were 59% lower, total costs were 57% lower $2358 -> $1095 P=0.009 11

This may have given PC a shot in the arm when it needed it – 2004. CEOs read this. “I want to send a team down to learn how to do this palliative care….” 12

The WHO: all data are LOCAL. It only matters if it is from your shop. Know your audience. Senior Director, Financial Planning & Cathy Lu, Analysis for Johns Hard working PhD JH FAU Hopkins Medicine student with 3 analyst, and (JHM), $8 Billion years financial her boss consulting Administrators experience for ONC and PC 13

Objectives We can all take good care of people. 1. Proving that we contribute to the bottom line is key. 2. “Mission alignment.” Basics 3. – Who – What – the cost savings + the professional fees – Where – When – Why 4. How to present the data. 14