A Quality Improvement Project to Improve Financial Sustainability and Efficiency of Home Palliative Care
Description
PURPOSE Home palliative care services are challenging to bill due to the complexity of services and competing time demands on staff. A protocol was developed for providers to guide coding and billing to increase Relative Value Unit generation to improve financial sustainability. SUBJECTS: Nurse practitioners (N=7). METHODS AND MATERIALS: A mixed method quality improvement project was conducted in a home-based palliative care program in the Midwest. Data were collected during on observation of advanced care planning conversations on home visits; and on advanced care planning and billing, visits by discipline, revenue generation, and codes utilized were examined and feedback provided to individual providers. Knowledge and satisfaction (pre/post) were examined. ANALYSES: Thematic analysis and descriptive statistics and chi-square were used. RESULTS: Clinician knowledge increased a mean of 2.0 (2.7-4.7 [of 5]) after education; and 100% were satisfied. There were 16.7% (n=60) initial visits examined prior to implementation and 83.3% (n=55) after. Improved advanced care planning length (2.3-minutes; [18.5 to 20.8]), documentation (18.3% [61.7% to 80%]), and billing (36% [16.7% to 52.7%]) occurred as a result of the project. CONCLUSIONS: Billing and coding practices can be improved through use of coding protocol, education, and audit and feedback to support financial sustainability.
A Quality Improvement Project to Improve Financial Sustainability and Efficiency of Home Palliative Care
PURPOSE Home palliative care services are challenging to bill due to the complexity of services and competing time demands on staff. A protocol was developed for providers to guide coding and billing to increase Relative Value Unit generation to improve financial sustainability. SUBJECTS: Nurse practitioners (N=7). METHODS AND MATERIALS: A mixed method quality improvement project was conducted in a home-based palliative care program in the Midwest. Data were collected during on observation of advanced care planning conversations on home visits; and on advanced care planning and billing, visits by discipline, revenue generation, and codes utilized were examined and feedback provided to individual providers. Knowledge and satisfaction (pre/post) were examined. ANALYSES: Thematic analysis and descriptive statistics and chi-square were used. RESULTS: Clinician knowledge increased a mean of 2.0 (2.7-4.7 [of 5]) after education; and 100% were satisfied. There were 16.7% (n=60) initial visits examined prior to implementation and 83.3% (n=55) after. Improved advanced care planning length (2.3-minutes; [18.5 to 20.8]), documentation (18.3% [61.7% to 80%]), and billing (36% [16.7% to 52.7%]) occurred as a result of the project. CONCLUSIONS: Billing and coding practices can be improved through use of coding protocol, education, and audit and feedback to support financial sustainability.