Palliative care in a community-based oncology private practice.

Abstract

107 Background: Integration of palliative care in the outpatient oncology clinic improves the quality of care for patients with advanced cancer. While models of outpatient palliative care (PC) in the academic oncology clinic have been demonstrated, the feasibility of PC in a private practice oncology clinic has not been established. Methods: In 2014 our 8 office oncology practice composed of 30 physicians and 10 advanced practice providers hired a full-time PC physician. Our questions included: 1) Would the PC physician be valued by the oncologists in the practice; 2) Would internal referrals and follow-up encounters provide sufficient activity for PC physician employment; 3) Would the revenue received for patient encounters offset the cost to the practice of the PC physicians? We emailed a survey to providers; we tallied data on patient encounters; and we reviewed the actual dollar amount of reimbursements received from payers for PC evaluation and management codes for a 1 year period. Results: In our second full year, a single palliative care physician saw 487 initial consultations and 1273 follow-up encounters for a total of 1760 encounters. The collected revenue for these encounters covered 102% of the palliative care physician’s combined salary and overhead. This data enabled the additional hiring of a second PC physician in 2016. Of 36 providers surveyed, 24 (67%) completed our 10 question survey. On a 1-5 point scale, when asked to rank the positive influence of the palliative care program on the culture of patient care in the practice, the aggregate score was 4.96. When asked questions on how helpful the palliative care program was to the providers in managing a variety of patient concerns, all items scored between 4.5 and 5. A question on how helpful the PC physicians were as a curbside resource received an aggregate score of 5.0. Conclusions: Based on referral numbers and surveyed attitudes, PC physicians were readily accepted into the fabric of a community based oncology practice. Analysis of financial data demonstrates that the PC physician can cover a substantial part of their salary requirement through billing for patient encounters.