1. Outpatient Palliative Medicine Region 12 Learning Collaborative Project Presentation - Covenant Health Christi Taylor May 4, 2016

2. Our Purpose The Covenant Health Palliative Medicine program identified a need for community-based out patient clinic to support patients with life- limiting chronic diseases that need supportive care, goals of life care planning, and advanced symptom management.

3. About the Clinic Opened in February 2014 Providers ▫Terrie Klein, FNP-BC ▫Melanie Oblender, MD – part-time Staffing ▫RN – Jeanette Hill ▫Social Worker – Destynee Nobles ▫Patient Rep – Dramika Johnson ▫Chaplain services as needed Over 500 patient visits to date

4. Our Milestones and Metrics Milestone #1 ▫Increase the number of PM consults Milestone #2 ▫Percentage of inpatient PM patients discharged to home care, hospice, or SNF Metric #1 ▫Percent of total in-hospital deaths on the PM Unit who had a palliative care consult ▫Participate in semi-annual face-to-face meetings or seminars organized by RHP Category 3 ▫Pain assessment ▫Spiritual/religious concerns ▫Treatment preferences

5. Challenges/Lessons Learned #1 Challenge: Physician Recruitment ▫Lesson #1 – A good midlevel provider can carry the program Challenge #2: Physician understanding and buy-in ▫Lesson #2 – Not everyone understand the difference between palliative care and hospice and even fewer understand how outpatient palliative care can help their patients with chronic diseases  Educate early and often, never assuming that physicians understand what you have to offer  Don’t stop with physicians – educate nurses, social workers, case managers, practice managers, home health staff, nursing home staff, etc. to the benefits of outpatient management in the palliative clinic in hopes that they can influence physician referrals

6. Challenges/Lessons Learned Challenge #3: Volume ▫Lesson – Cannot drive volume with mastering Lesson #2! # 4 Challenge: Payor Mix – Not enough Medicaid and self pay ▫Lesson #4 – Your referral base determines your payor mix. Must expand referral base to more needs-based providers to drive increase in Medicaid and self pay referrals.

7. Success Story Helping someone along the path to recovery…