Effective Hospital-Based Palliative Care Programs: Staffing Needs and Cost Savings West Virginia Center for End-of-Life Care September 13, 2006. Lynn Spragens, MBA Spragens & Associates, LLC Durham, NC Lynn@LSpragens.com 919-309-4606 www.capc.org. Objectives.
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Effective Hospital-Based Palliative Care Programs: Staffing Needs and Cost SavingsWest Virginia Center for End-of-Life CareSeptember 13, 2006
Lynn Spragens, MBA
Spragens & Associates, LLC
US Census Bureau, CDC, 2002.
Palliative Care: Bridging Restorative and Comfort Care
Disease Modifying Therapy
Curative, or restorative intent
Diagnosis Palliative Care Hospice
Billings JA et al J Pall Med. 2001, AHA Survey 2002, Pan CX et al J Pall Med. 2001
Public Awareness is Growing Association & F. Ferris, MD
March 10, 2004 Association & F. Ferris, MD
Re-defining Your Brand
Palliative Care Is NOT:
“Top Down” Association & F. Ferris, MD
# of deaths
# wt long stays
2 – 7% of patient admissions = estimated demand
Patients wt certain DRGs
With LOS > xxx
Admitted from SNF
Certain locations (MICU)Volume – Two Methods
Adequate Staffing Association & F. Ferris, MD
To develop and meet
demandDilemma: Chicken or Egg?
Adequate Volume to demonstrate savings and justify the program
If we do this, then the undesirable outcome does NOT happen…How do we get credit for what DID NOT happen???
Total Costs Association & F. Ferris, MD
Those costs that do not vary directly with
volume. Over a specified period these
costs would be incurred regardless of
volume. As shown below, fixed costs
have two components.
Costs that vary directly and proportionately
with the volume of patient services provided.
These expenses may fluctuate day to day
and would not be incurred if no services
were used. As shown below, variable
costs have two components.
Costs that cannot be
specifically traced to an
individual department and
do not vary with volume.
These costs are allocated to
all departments. Examples:
VARIABLE DIRECT *
Costs that can be traced to
a specific product or service.
These costs increase or decrease
according to the volume of
services. Examples: nursing
The costs or expenses that
cannot be specifically traced
to an individual patient but
which do vary with volume.
Examples: social services,
Costs that can be traced
to or identified with a
specific product or service
but that do not vary with
Courtesy of Kathleen Kerr, UCSF, 2/1/05
4 Association & F. Ferris, MD
VolumeSemi-variable cost behavior for Savings and Revenue
Reality = “Breakpoints”
Per day costs: pre- and post-referral Association & F. Ferris, MDMaking the Financial CaseCosts Pre & Post Palliative Care Referral
Charts courtesy of J Brian Cassel, PhD, Massey Cancer Center, Virginia Commonwealth University Smith et al. J Pal Med 2003
(Based on 583 palliative care consult patients discharged alive. First days and last days of stays excluded.)
Carle Foundation Hospital: 190 beds (2 yr old service, 35+ new patients/mo)
DASHBOARD: Time Before, Time After new patients/mo)