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How to Establish a Palliative Care Program

Pioneer Program Case Examples

Clinicians at nine hospitals describe how they and their colleagues established formal programs of palliative care.

You may review the full report, or select a particular program from the list below (This work was supported by Milbank Memorial Fund, and the The Robert Wood Johnson Foundation):

Balm of Gilead Center, Cooper Green Hospital,
F. Amos Bailey, Birmingham, AL

Palliative Care Program, Beth Israel Deaconess Medical Center/CareGroup,
Lachlan Farrow, Boston, MA

The Harry R. Horvitz Center for Palliative Medicine, The Cleveland Clinic Foundation,
Declan Walsh, Cleveland, OH

Massachusetts General Hospital Palliative Care Service,
J. Andrew Billings, Boston, MA

Palliative Care Program, Medical College of Virginia Campus of Virginia Commonwealth University,
Laurel J. Lyckholm, Patrick Coyne, and Thomas J. Smith, Richmond, VA

Pain and Palliative Care Service, Memorial Sloan-Kettering Cancer Center,
Richard Payne and Kathleen M. Foley, New York, NY

The Lilian and Benjamin Hertzberg Palliative Care Institute, Mount Sinai School of Medicine,
Diane E. Meier, Jane Morris, and R. Sean Morrison, New York, NY

Palliative Care and Home Hospice Program, Northwestern Memorial Hospital,
Charles F. von Gunten, Chicago, IL

Comprehensive Palliative Care Service, University of Pittsburg-UPMC,
Robert Arnold, Pittsburgh, PA

CAPC Resources:
Additional case examples:
Blount Memorial Hospital, Maryville, Tennessee
Palliative CareCenter and Hospice of the North Shore

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Help develop CAPCManual. Send your comments, questions, suggestions to: fferris@sdhospice.org
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CAPCManual Attribution:  von Gunten CF, Ferris FD, Portenoy RK, Glajchen M, eds. CAPCManual: How to Establish A Palliative Care Program. New York, NY: Center to Advance Palliative Care, 2001.   © Center for Palliative Studies, San Diego Hospice & Palliative Care, San Diego, CA and
The Department of Pain Medicine and Palliative Care, Beth Israel Medical Center, New York, NY, 2001

Permission to reproduce for non-commercial educational purposes with display of attribution and copyright is granted.
Last updated: February 20, 2002

Elements
Select section:
Basis, Context, Components, Case Examples

•  Basis of Palliative Care Practice
      Palliative Care Definitions
         Historical Definitions
            WHO
            Oxford Textbook
            ABHPM
            NHPCO
         Palliative Care
         Applicability
         Application to Patients at Risk
         Differences–Hospice & Palliative Care
      Values, Ethical Principles
         Values
         Ethical Principles
      Conceptual Framework
         Square of Care
         Square of Organization
         Square of Care & Organization
      Norms / Standards of Practice
      Guidelines
      Policies, Procedures
         What are They?
         Developing, Implementing, Evaluating
      Measures
      Definitions of Common Terms
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•  Context
      Tensions
         In Therapeutic Relationships
         Within Host Organizations
         Within Healthcare System, Community
      Who's the Customer
      US Healthcare
         Acute Care Hospitals
         Long-term Care Facilities
         Home
         Hospice Care
      Financing US Healthcare
         Expenditures for EOL Care
         Overview by Settings, Revenue Sources
            Medicare
            Medicaid
            Commercial Insurers
            Managed Care
            Government (VA, Military)
         Financing
            Community Hospitals
            Academic Hospitals
            Subacute, Skilled Care
            Custodial Care
            Ambulatory Care
            Home Care
            Hospice Care
                  Eligibility
                  Covered Services
                  Reimbursement Rates
                  Unintended Consequences
         Financing Physicians
            Coding
               Procedure / Service Codes
                  Coding Based on Time
                     Frequently Used E/M Codes
                        Example
                  Addition of Procedure Codes
            Diagnosis Codes
               ICD-9 Codes for Palliative Care
               Avoiding Concurrent Billing Problems
                  Example
            Documentation
               Example
            Physician Reimbursement
               Medicare
                  Medicare Hospice Benefit
                     Non-hospice Physicians
                     Associated with a Hospice
               Medicaid
               Commercial Insurers
               Managed Care
               Government (VA, Military)
         Financing Non-physician Providers
      Hospital–Hospice Relationships
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•  Program Components
      1º, 2º, 3º Model of Palliative Care Delivery
      Interdisciplinary Care
         Members of Interdisciplinary Team
            Core Competencies
               Physician
               Nurse
               Social Worker
               Chaplain
               Volunteer
      Specialized Environments
      Types of Services
         Consultation Services
            Consultation Etiquette
            Consultation Documentation
               Sample Note
         Inpatient Units
            Developing an Inpatient Unit
               Staffing
               Acuity
               Nursing Model
               Unit Size
                  General Ward vs. Palliative Care Unit
            Roles
            Decisions
            Case Example
               Nursing Staff
               Physician Staff
               Other Staff
               Advice
         Home Care
            Eligibility, Medicare Home Health Benefit
               Covered Services
               Usually Not Covered
         Hospice Care at Home
         Ambulatory Outpatient Care
         Respite Care
      Financing Palliative Care Programs
         Acute Hospital
         Skilled Care Nursing Home
         Hospice
         Home Health
         Ambulatory Outpatient
         Managed Care
      Financing Physicians in Palliative Care
      Financing Non-physicians in Palliative Care
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•  Case Examples
      CAPCManual Case Examples
      Pioneer Program Case Examples
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