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Wednesday, January 16, 2013 Audio Conference 1:30 – 2:30 PM EDT

The IPAL-OP (Improving Outpatient Palliative Care) Project is a project of the Center to Advance Palliative Care, with support from The Fan Fox and Leslie R. Samuels Foundation, Inc. OACIS Home-based Service: Delivering Palliative Medicine in the Home.

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Wednesday, January 16, 2013 Audio Conference 1:30 – 2:30 PM EDT

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  1. The IPAL-OP (Improving Outpatient Palliative Care) Project is a project of the Center to Advance Palliative Care, with support from The Fan Fox and Leslie R. Samuels Foundation, Inc. OACIS Home-based Service: Delivering Palliative Medicine in the Home Wednesday, January 16, 2013Audio Conference1:30 – 2:30 PM EDT Donna Stevens, BS Advisory Board, IPAL-OP Program Director, OACIS Services Lehigh Valley Health Network Allentown, PA Email: donna.stevens@lvhn.org Daniel E. Ray, MD Director, Palliative Medicine/OACIS Fellowship Director, Hospice and Palliative Medicine Lehigh Valley Health Network Allentown, PA Email: daniel.ray@lvhn.org

  2. The Shoulders We Stand On • Lou Lukas, MD • Department of Family Medicine • Ann Casterlin and Home Health Services Division • Physician Hospital Organization • Department of Medicine • CAPC

  3. Objectives • Describe how program reflects network mission and local setting • Identify unique needs of patients with advanced complex illness (ACI) • Describe core operational features

  4. Objectives • Identify key quality metrics for a home-based palliative medicine service • Describe the value proposition of palliative care • Describe the role of palliative care in the changing health care environment

  5. History of Palliative Care at LVHN • ICU • Home-based palliative care • Oncology • Needs assessment • Future Search • Community Care for Complex Illness (3CI)

  6. Further Development of Palliative Care at LVHN • OACIS • Community Exchange • GOALTX • PalMS • NCCCP • Section

  7. Program Goals • Improve symptom management and quality of life • Help patients clarify their values to direct care decisions • Avoid unnecessary hospitalization through care coordination and medical management • Support the LVHN system goals of care improvement for patients with chronic life-limiting illness • Develop strong linkages with the PCP to ensure collaborative approach

  8. Home-Based Program Staff (FTE) • 5.8 Palliative care nurse practitioners • 0.2 Physician • 0.5 Program director • 1.0 Clinical coordinator • 0.5 Secretary • Ancillary staff: Social worker, pastoral care, psychiatric nurse, financial analyst

  9. Patient Population • Adult patients at any age and any stage of an advanced complex illness (ACI) • 700-square mile catchment area (expanding) • Most patients: • Have multiple comorbidities • Utilize significant health care resources (hospital, office etc.) • Require additional medical management/supports at home

  10. Referral Sources • Community primary care and specialty physicians • LVHN inpatient palliative care team upon discharge • Hospital discharge planning staff • Other hospital-based clinicians

  11. Patient Population (cont’d.):Illness Trajectories

  12. Program Scope of ServicesThe Four Pillars* *This table was taken from: Lynn M Deitrick, Elke H Rockwell, Nancy Gratz, et al (2011). Delivering Specialized Palliative Care in the Community: A New Role for Nurse Practitioners. Advances in Nursing Science, 34(4):E23-36.

  13. Care Management/Coordination • “Looking at the big picture” • Patient’s definition of quality of life • Patient’s priorities • Synthesizing fragmented care • Coordinating several physicians and agencies • Fostering relationships

  14. Medical Management • Medical decision making • Manage chronic illness • Symptom control • Address acute issues • Identify emerging issues

  15. Psychosocial Support • Building trust • Allowing time to listen • Becoming an advocate • Empowering patients • Returning some control to their lives

  16. Education • Provide individualized information • Teach self management skills • Act as a guide for: • Progression of illness • Medical system • Transition to hospice

  17. Daily Operational Features • A virtual office w/office-based clinical coordinator • Hours: Monday-Friday 8:00AM-4:30PM • Referrals managed/triaged by clinical coordinator • Home visits based on patient urgency

  18. Daily Operational Features (cont’d.) • Initial home visit 1-2 hours • Collaboration/communication with PCP • Follow-up visits as per patient acuity • Collaboration with Home Care and transitions to Hospice

  19. Daily Phone Calls

  20. Operational Metrics • New referrals/month: 45 • Average time to first visit: 14 days • Per CRNP FTE: • Home visits/month: 63 • Expectation = 3 visits/day • NP time analysis: 1/3 in home, 1/3 documentation, 1/3 travel • NP case load: 107 • Patient turnover/year: 100 • Travel/month: 510 miles

  21. Financial Metrics FY12(assume 3.8 CRNP) • Total visits: 2,376 • wRVU/year: 2200/CRNP • Revenue (billing): $300,000 • Net revenue/patient: $131 • Net revenue as % of direct cost: 80%

  22. Scorecard

  23. Key Points • Network Mission-Based • Medical Specialty • Relationship centered • PCP, referring provider • PCMH • Population management (ACI expertise) • Health care utilization

  24. Clinical Metrics • Clinician-rated ESAS (Edmonton Symptom Assessment System) • Initial data review • Planned project to improve interrater reliability • GOALTX • Initial data review • Planned project to assess quality

  25. Quality Metrics • Scorecard • Patient satisfaction • New patient survey development • Referring provider satisfaction • Cost avoidance

  26. Patient Satisfaction Survey [FY12 Initial] (n=142)

  27. Referring Provider Satisfaction FY11 (n=25)

  28. Cost Avoidance (LVHN Data)

  29. Health Care Environment • Projected primary care physician shortage • New role for nurse practitioners • Focus on team-based care • Patient-Centered Medical Home • ACO context

  30. Visit The IPAL Project!at www.capc.org/ipal

  31. New IPAL-OP Portfolio Resources Resources coming soon…. • Profiles for Clinic and Pediatric Programs • Metrics and Finance Topics in development include… • Review of Impact Data • Delivery of Outpatient Clinical Care

  32. For More Information • Visit IPAL-OP at: www.capc.org/ipal/ipal-op • Download IPAL-OP portfolio products athttp://www.capc.org/ipal/ipal-op/monographs-and-publications

  33. Question & Answer Period Thank you for joining us today! ABOUT CAPC The Center to Advance Palliative Care (CAPC) provides health care professionals with the tools, training and technical assistance necessary to start and sustain successful palliative care programs in hospitals and other health care settings. Located at Mount Sinai School of Medicine, CAPC is a national organization dedicated to increasing the availability of quality palliative care services for people facing serious illness.

  34. Continue the Discussion on CAPCconnectTM Forum! At the conclusion of this audio conference, we welcome you to continue the discussion with your peers and faculty on CAPCconnectTM Forum! Go to: http://www.capc.org/forums to post your message and comments in the “Palliative Care Out-Patient Services” discussion topic!

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