Behind the Scenes: The Care Coordination/Non-Billable Time Associated with Outpatient Pediatric Palliative Oncology (S808)

Abstract

1.Describe the unique aspects of a pediatric palliative oncology clinic and the time spent in care coordination.2.Identify the demographic and disease-based factors that contribute to increased care coordination time.3.Formulate talking points to advocate for appropriate care coordination time in your outpatient clinic model. Integrated pediatric palliative oncology (PPO) outpatient models are emerging to assist oncologists and patients with longitudinal support, symptom management, and care coordination. Considerable time is devoted to care coordination, but the scope, time per patient, and ratio of non-billable to billable (NB:B) minutes is unknown. This information is crucial to designing new PPO outpatient clinics in order to understand and advocate for appropriate personnel, physician time, and resources. To determine the trends and ratio of NB:B minutes for PPO clinic patients. All encounters were tracked from June 2017 through April 2018 for a single-institution 1-day per week PPO clinic. Administrative minutes and PPO inpatient time were excluded. Billable and non-billable (e.g. care coordination) minutes were recorded. Descriptive statistics were conducted. The overall ratio of NB:B minutes and ratios by diagnosis type and vital status were calculated. One-way ANOVA and chi-square tests were used to assess differences in the NB:B ratios. Out of 98 patients, PPO had billable visits on 54 (55%) and assisted without billing in the care of 44 (45%). Twenty-four (25%) patients are deceased; vital status did not differ by diagnosis type (p=0.29). Patients had solid tumors (ST; 42, 43%), brain tumors (BT; 33, 34%), leukemia/lymphoma (L/L; 21, 21%), and other diagnoses (2, 2%). Overall NB:B ratio was 1.03. NB:B ratios differed among diagnoses (p<0.0001), with L/L the highest at 2.5 compared to ST (0.9), BT (0.8) and other (0.5). Deceased patients had a higher ratio of NB:B minutes than alive patients (p<0.0001; 1.9 vs 0.8). Care coordination in PPO clinic is time-intensive and grows with clinic volume. For patients with L/L and those who were deceased, non-billable minutes outpaced billable clinical minutes.