Securing Future Economic Strength for Hospice/Palliative Care

Client: A Catholic Hospital offering acute end-of-life inpatient care and outpatient palliative care and hospice services, whose providers deliver a combination of direct patient care, teaching and administration. Care is driven by inpatient primary care but also includes wound care and a few specialty services. Its parent company also owns 20+ skilled nursing facilities (SNF), whose providers would eventually be rolled into the practice plan.

Distinctive Factor: Unique in its focus on end-of-life care.

Situation: The hospital faced financial challenges due to inadequate reimbursement rates provided by the city, internally antiquated technology, and poor financial management. The client’s goals in engaging Dreskin were deficit reduction and the retention of provider revenue in the system. At the time of the engagement, there were no tracking tools for daily service delivery and charge capture, or quality.

Engagement: Dreskin and his team were charged with designing a new incentive-driven provider compensation plan to ensure future economic strength, initially with the hospital and then throughout the SNFs.

The new faculty plan needed to generate revenue due to a disadvantageous payor mix. The plan entailed creating incentives for productivity, quality of care, patient satisfaction, and community services.

Dreskin’s team took a three-phased approach:

1. Fact Based Analysis to assess all business operations and gain a full understanding of the previous medical staff organization and revenue cycle management details. The deep fact-finding resulted in clinical and operational recommendations that included new interview processes, and included projected benefits from each recommendation.

2. Option Development to develop model options for C-Suite and physician consideration.

3. Model Finalization and Implementation Support for the selected model. The team developed benefit structures and costs, rolled the model out to physicians, and prepared contingency plans for potential resignations. They provided training to code encounters accurately. The scope included recruitment, an integrated future model, and rate negotiations.

Outcome:

• Increased coding performance: 3% level 3 to 40% level 3

• Increased recruitment with five new physicians and three new nurse practitioners

• Home Hospice case volume up 50%