Productivity Benchmarking in Palliative Care: What We Know and Where to Start

Productivity in palliative care is a tricky subject. Clinicians and program leaders ask about it all the time, yet it remains difficult to define “optimal palliative care productivity”. Palliative care involves complex, interprofessional, time-intensive work that doesn’t fit neatly into traditional productivity metrics.

Productivity in palliative care is a tricky subject. Clinicians and program leaders ask about it all the time, yet it remains difficult to define “optimal palliative care productivity”. Palliative care involves complex, interdisciplinary, time-intensive work that doesn’t fit neatly into traditional productivity metrics.

So, how do we measure productivity in palliative care? How many patients should a clinician see daily? How many work Relative Value Units (wRVUs) should be generated annually?

The answer: it depends—on team composition, practice norms, care setting, billing knowledge, and patient mix. But despite these variables, emerging data offer a starting point for meaningful discussions.

Benchmarking can help programs set expectations and advocate for resources, but palliative care’s unique nature presents several challenges.

Palliative care is delivered in diverse environments, including inpatient hospital consult services, outpatient clinics, home-based palliative care, skilled nursing facilities, and hospice-led programs. Each setting operates differently, making direct comparisons difficult.

Palliative care is more than just seeing patients and generating wRVUs. Clinicians also lead family meetings, which are time-intensive, emotionally complex conversations; engage in advance care planning; collaborate with interprofessional teams; and educate and mentor.

While billing and coding improvements have helped capture more of this work, many essential palliative care activities still go unrecognized in traditional productivity metrics.

Palliative care focuses on symptom management, complex decision-making, and quality of life—areas that don’t always fit standard productivity models. Spending more time with fewer patients may be necessary for high-quality care, yet most benchmarks reward higher patient volumes.

For example, a clinician who conducts three 90-minute goals-of-care conversations may provide just as much long-term value (avoidance of hospitalizations, improvements in quality of life) as another who sees eight quick follow-ups—but traditional metrics don’t always reflect that.

Palliative care teams often include physicians, advanced practice providers (APPs), nurses, social workers, and chaplains—but staffing models differ across programs. Some teams rely heavily on APPs for initial consultations, and some may utilize nursing, chaplains, and social work, while others have physician-heavy models. Staffing mix is heavily influenced by payment source and organizational clinical culture. Benchmarks must be flexible enough to accommodate these differences.

Palliative care has historically faced challenges in billing and reimbursement. Many clinicians undervalue their time and the complexity of the work they do. For instance, just because a patient encounter comes naturally doesn’t mean it wasn’t high-complexity work that could be billed accordingly. Without training in billing and coding, and standardized billing practices, wRVU-based benchmarks may not accurately reflect a palliative care team’s clinical workload.

Palliative care is emotionally demanding. As my old social work colleague Kate Magnant once said, “Sometimes we just need a quiet space to cry or bang our heads against the wall.”

Clinicians frequently manage grief, existential distress, and complex family dynamics. Unlike procedural specialties, where increasing patient volume might not affect well-being, high patient loads in palliative care can lead to distress, fatigue, and burnout—or drive people out of the field entirely.

A benchmark that prioritizes volume over sustainability is ultimately a risk to both clinician well-being and patient care.

There isn’t a universal benchmark for palliative care productivity, but past studies provide some useful reference points:

• 2010 AAHPM survey (29 respondents): Mean of 2,400 wRVU per year per clinician
• 2021 MGMA report: Palliative care clinicians generated an average of ~2,100 wRVU per year
• 2022 study (American Journal of Hospice and Palliative Medicine)
  • One program benchmarked at 4,250 wRVU annually per billing clinician
  • Four other programs did not set benchmarks

While these numbers offer guidance, they must be interpreted with caution. Care settings, team structures, and patient populations vary widely.

To get more real-world insights, CAPC reached out to palliative care programs via email, virtual events, and CAPC Circles discussions. Here’s what we found:

Email and Virtual Event Outreach (25 Program Responses)

• Average billing clinician productivity: 2,300 wRVU per year
• Average billing clinician productivity: 12 wRVU per shift

CAPC Circles Discussion (7 Respondents)

• Physicians: 2,300–3,400 wRVU per year
• APRNs: 1,500–2,700 wRVU per year

These data come with a lot of caveats—information collection was informal, and mixed inpatient and outpatient feedback. But these findings align with the literature, suggesting that while variation exists, a general pattern is emerging.

Given these insights, a proposed starting benchmark appears to be 2,500 wRVU per year for palliative care clinicians. This is not a hard rule—site-specific factors will shape the actual number—but we think it’s a reasonable place to begin.

This suggested benchmark gives programs a baseline for evaluating productivity while allowing flexibility for different institutional needs.

Productivity isn’t just about numbers—it’s about sustainability. Here’s why it matters:

• Programs get asked about it constantly. Leadership, funders, and stakeholders all want to know.
• It helps clinicians self-assess and compare against peers, making it a useful tool for performance evaluation.
• It’s tied to revenue. Many institutions link productivity to financial sustainability.
• It impacts salaries and job expectations. Some contracts include wRVU targets in compensation structures.
• But more than anything, benchmarks provide a foundation for discussion, helping teams set fair and attainable expectations.

Given variability in patient acuity and setting, a typical day will look different across programs. However, a starting point might be:

Again, this is not a rigid standard but a framework that allows room for customization.

Productivity in palliative care will never be as straightforward as in other specialties. The diversity of care settings, team roles, and patient needs makes benchmarking challenging.

However, based on literature, field data, and real-world discussions, a starting benchmark of 10–12 wRVU per day (or ~2,500 annually) is reasonable. Programs can refine these figures based on their own circumstances—but having a benchmark, even a flexible one, helps with planning, evaluation, and advocating for resources.

It’s not about squeezing in more visits. It’s about ensuring that palliative care teams have the support and structure needed to provide high-quality care.

Let’s continue refining these numbers together—because productivity matters, but so does sustainability. Connect with CAPC through CAPC Circles, Virtual Office Hours, and webinars. The more feedback we get on this topic, the more we can hone benchmarking in for our field.

CAPC has various resources to help you with billing and productivity—along with many other topics. Here are just a few which we encourage you to review:

• Billing and Coding, a toolkit which offers tools and technical assistance around billing and coding. Palliative care team members use this toolkit time and time again.
• Let’s Shift How Palliative Care Teams are Measured and Valued, a blog which makes the case that RVUs aren’t the best way to measure palliative care program value, written by Christopher Jones, MD, MBA, and Phillip Rodgers, MD.
• Everything You Always Wanted to Know About RVUs But Were Too Afraid to Ask, Additionally, a blog exploring the history and mechanics of relative value units (RVUs) to demystify and support constructive use, written by Lynn Hill Spragens, MBA and Allison Silvers, MBA