Table 3D.

Profile of a Hospice-Based Clinic

Name (contact)	Hospice of the Bluegrass, Lexington, KY (Dr. Todd Cote)
Patient volume	180 patients per year, including 90 new
Patient characteristics	30% with cancer, most common noncancer diagnoses are heart failure, chronic obstructive pulmonary disease, and dementia. Major reasons for referral are symptoms and goals-of-care discussions. 50% of referrals are from inpatient palliative care consultation services, 20% from oncologists, and 20% from primary care providers.
Practice characteristics	6 half-days of clinic/week with average of 3 exam rooms available per clinic session. New patient visits are 90 minutes, follow-up visits 30 minutes. Wait time averages 7 days.
Staffing	1 half-time physician, 1 full-time social worker, 1 full-time nurse (RN)
Funding	60% institutional support and 40% billing
Routinely collected data	None
Impetus for starting	This practice started 8 years ago to “Fill in community care ‘gaps’ and offer post hospital support for patients who received a palliative care consult.”
Innovation	Offers telemedicine services for patients in rural Appalachia.
Definition of success	High utilization of home health and hospice services.
Challenges faced	Generating enough patient referrals, “Not becoming a chronic pain clinic.”