There is a misconception within the care at home industry that community-based palliative care will be a loss leader for an organization. This perspective doesn’t take into account the care and positive outcomes that can be achieved through well-defined and organized palliative care delivery. Though profitable revenue models are a challenge to achieve in this landscape, the foundation of insight into the sustainability of any community-based palliative care program should be strong key performance indicators (KPIs) to outline the return on investment of the program.
This blog is the second of a series that focuses on actionable ways to define return on investment (ROI) and outlines common palliative KPIs to show impact. All ROIs are financially driven metrics; this blog focuses on the financial KPIs that can help define success. Future blogs will focus on patient outcome and partnership KPIs.
If a community-based palliative care organization is doing fee-for-service professional billing, these metrics can be used to determine financially based ROIs.
1. Billing Codes
The routinely used billing codes should be analyzed regularly to determine missed opportunities. Examples of often-missed opportunities when billing include:
- Leveraging complexity versus time-based evaluation and management codes.
- Capitalizing on advance care planning codes.
- Reviewing the use of non-face-to-face billing codes and ensuring proper utilization of prolonged service codes.
2. Timely Billing
The amount of time until a claim is generated, submitted and paid can all be analyzed, leading to insights into potential breakdowns in the revenue cycle management process. Any denials or additional documentation requests (ADR) should also be tracked.
3. Revenue
Revenue should be analyzed in total revenue per month (by provider) and revenue per visit. This information can also be compared against the average direct cost of a visit.
4. Service Area Expectations and Drive Time
Unlike hospital-based palliative offerings, community-based palliative care organizations need to factor in the service area when considering financial KPIs. The service area and drive time spent by the team can be a significant, direct cost to palliative care in the home. This metric is particularly impactful if the organization is caring for patients in a remote or rural area.
5. Provider Case Load and Average Visits Per Day
Provider caseloads and visits per day (or equivalent visits per day) should be monitored and a benchmark should be identified to ensure productivity is sustainable.
Utilizing the KPIs outlined in this blog can be a strong way to incorporate financial measures into an analysis of a community-based palliative care program’s ROI. While a program’s ROI should not be solely dependent on income, the financial sustainability of a program is critical to providing high-quality care. Financial KPIs are one piece of the puzzle, but they are an important piece and should be monitored regularly.
Axxess Palliative Care, a cloud-based palliative care software, offers a robust suite of reports that can make abstracting and monitoring palliative specific KPIs easier.
This blog series is written in collaboration with Mark Hendrix of nTakt.