Advanced Palliative Care Organizations -An Organizational Model to Distribute Palliative Care

Hospices are especially adept at managing patients close to the end-of-life. My study suggests there are two reasons - because the number of such patients that hospices serve is so large (more than 50% for many hospices) AND because the most challenging patients (clinically and financially) are those with lengths of stay of 10 days or less. Several research studies have found that the most costly periods of care, under the hospice benefit, are the FIRST five days of enrollment on the hospice benefit and the LAST five days of life. So it's natural to expect that hospices will become proficient in managing "short-stay" patients.Currently, palliative care in this nation is organized, and thus delivered, around the hospice benefit. No question, greater accessibility to better end-of-life care has resulted since Medicare introduced the hospice benefit. I believe most of us would agree,however, that palliative care applies to many more patient populations than those fast approaching end-of-life. How can we best assure that chronically ill populations benefit from palliative care? By reorganizing, around Advanced Palliative Care Organizations, how health care is provided to those with life-limiting diseases.

Defining the Role of Medical Leadership in Successful Palliative Programs

The keys to success, we've found through study and experience, are to align expectations and to create an organizational structure that enables easy scaling to accomodate growth.Job specifications based upon program metrics generally produce the best results , that is to say, the role of program director is best determined by identifying and incorporating into the position profile the program expectations from at least three and not more than five "stakeholders', including the CEO. This can best be done done by an outside consultant who will not inject "bias" into the assessment.

Removing Barriers to Success

I'm often asked what keeps programs from reaching their potential? Several factors, but one stands out.
A program can be successfully STARTED with less than 1.0 FTE - the challenge becomes in sustaining the program with such limited staffing. The shortage of palliative care specialists makes timely scaling of the program one of, if not the greatest, management challenges. Those that have been able to SUSTAIN the program with limited staffing have done so because they've effectively brought infrastructure (intellectual capital) to the program at the right time and in the right amount. Yet , as one might surmise, doing so demands management agility and acumen and, most precious of all, time. These are resources in short supply at most fledgling programs.
In future posts, we'll examine several other barriers to program growth, and how successful programs have surmounted those obstacles. Most of all, I'm curious to learn experiences of readers of this blog.

Two Parts Accomplishment, Three Parts Potential

Two parts accomplishment, three parts potential. That, to me, describes the current state of palliative medicine.
How can that be, you ask? After all, palliative medicine is now a recognized subspecialty. And the clinical domains of good palliative care are being adopted widely.
So why is the promise of palliative medicine yet to be realized, and what will it take to translate potential into accomplishment? While palliative medicine practices are delivering exceptional care to those with life-limiting illnesses, many demonstrate unfilled potential. Why? Because they’re undercapitalized; not financially, but intellectually. The bulk of each practice’s intellectual capital has been invested in the clinical knowledge residing in the physician’s head. And that’s the way it should be. But what about other intellectual capital—efficient workflow processes, coding expertise, knowledge of palliative medicine reimbursement nuances, practice analysis intelligence, software, and marketing know-how—so essential to the achievement of a high-performing practice? Most palliative medicine programs labor without this intellectual capital, and find themselves a year or two later scrambling to justify continued viability either of the practice itself or the palliative program associated with it.
Sponsors of palliative care programs, usually hospitals and hospices and most surely all well-intentioned, discover that sustaining (and growing) a program requires a different set of skills and expertise than developing the program. They also underestimate the importance of organizational structure in the success of the program. My aim is of this forum is that we'll examine the key elements of APCOs, the barriers to success and how they might best be removed, and why the shortage of palliative care specialists threatens to stifle the progress of end-of-life care.