Cost Savings Associated With an Inpatient Palliative Care Unit: Results From the First Two Years

Nathaniel, Jeremy D.; Garrido, Melissa M.; Chai, Emily; Goldberg, Gabrielle R.; Goldstein, Nathan E.

doi:10.1016/j.jpainsymman.2015.02.023

Cited by 29 publications

(21 citation statements)

References 27 publications

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“…Although the common perception is that provision of inpatient consultations is the easiest way to provide PC, there are cost benefits to having a dedicated PCU and consultations. Our study reinforces the findings of Nathaniel et al 13 that a patient's mean cost per day was $687 less while in the PCU, compared with before transfer to the PCU. In addition, the fact that the PCU was operating at 54% of capacity (using the unoccupied PCU beds for other patients) and was profitable confirms that PC is affordable.…”

Section: Discussionsupporting

confidence: 91%

Impact of a New Palliative Care Program on Health System Finances: An Analysis of the Palliative Care Program Inpatient Unit and Consultations at Johns Hopkins Medical Institutions

Isenberg

McQuade

et al. 2017

JOP

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Purpose: Palliative care inpatient units (PCUs) can improve symptoms, family perception of care, and lower per-diem costs compared with usual care. In March 2013, Johns Hopkins Medical Institutions (JHMI) added a PCU to the palliative care (PC) program. We studied the financial impact of the PC program on JHMI from March 2013 to March 2014. Methods: This study considered three components of the PC program: PCU, PC consultations, and professional fees. Using 13 months of admissions data, the team calculated the per-day variable cost pre-PCU (ie, in another hospital unit) and after transfer to the PCU. These fees were multiplied by the number of patients transferred to the PCU and by the average length of stay in the PCU. Consultation savings were estimated using established methods. Professional fees assumed a collection rate of 50%. Results: The total positive financial impact of the PC program was $3,488,863.17. There were 153 transfers to the PCU, 60% with cancer, and an average length of stay of 5.11 days. The daily loss pretransfer to the PCU of $1,797.67 was reduced to $1,345.34 in the PCU (−25%). The PCU saved JHMI $353,645.17 in variable costs, or $452.33 per transfer. Cost savings for PC consultations in the hospital, 60% with cancer, were estimated at $2,765,218. $370,000 was collected in professional fees savings. Conclusion: The PCU and PC program had a favorable impact on JHMI while providing expert patient-centered care. As JHMI moves to an accountable care organization model, value-based patient-centered care and increased intensive care unit availability are desirable.

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Section: Discussionsupporting

confidence: 91%

Impact of a New Palliative Care Program on Health System Finances: An Analysis of the Palliative Care Program Inpatient Unit and Consultations at Johns Hopkins Medical Institutions

Isenberg

McQuade

et al. 2017

JOP

View full text Add to dashboard Cite

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“…Similarly, a systematic review published in 2014 reported that PC is most frequently found to be less costly relative to other comparator groups, and in most cases, the difference in cost was statistically significant 22 . For the previously reported considerations, in our context home Palliative Care seems to be strictly correlated with local Public Health programs since both of them aim to improve quality of care for a particular group of patients and to allow a proper allocation of health expenditure 23 , 24 . According to these considerations, in Italy, the Consensus Conference held in Florence on June 2015 stated that all the people with advanced and/or progressive chronic conditions, complex care needs and limited life-expectancy may benefit from a palliative approach or palliative care 25 .…”

Section: Discussionsupporting

confidence: 51%

Hospital, local palliative care network and public health: how do they involve terminally ill patients?

Scaccabarozzi¹,

Limonta²,

Amodio³

2016

Eur J Public Health

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Background: Over one quarter of the health care expenditures is estimated to be spent for patients in the last year of life (LYL). For these patients, palliative care (PC) has been suggested as a response for improving the standards of care and reducing health costs. The aim of this study was to analyze a cohort of LYL people, in terms of comparing hospitalised patients who had been referred for PC to patients receiving usual care (UC). Methods: Retrospective study carried out on patients resident in Lecco (Italy) who died between 2012 and 2013. Records of patients were obtained from the Death certificate registry and cross-linked with Regional Healthcare Information System, Hospital Discharge Records and Palliative Care Registry. A total of 5830 patients were analyzed. Results: At least one hospitalization was reported by 2586 (44.3%) patients in the last month of life and 3957 (67.9%) patients in the last year of life. A total of 1114 (19.1%) patients were referred to palliative care with median duration of enrollment of 31 days (IQR = 11–69). PC was found to decrease the risk of hospital admission (adj-OR = 0.21; 95% CI = 0.18–0.26) and dying in hospital (adj-OR = 0.03; 95% CI = 0.02–0.04). Conclusions: Patients in the last year of life show a high risk of hospitalization, which represents a substantial component of health-care costs. Our study suggests that home PC consultation could represent an important public health strategy in order to lower hospital costs for LYL patients and reduce the probability of dying in hospital.

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“…However, there is a need to establish valid methods for cost estimates that consider both cost-effectiveness and cost-benefit analyses (outcomes translated to monetary units/dollars). Although studies have shown that palliative care interventions improve both patient-reported outcomes 3,5,57,[136][137][138][139] and cut costs for second party payers and hospitals, [140][141][142] most studies are relatively small-sized, and conducted from the health services perspective, not the societal perspective. 135 Thus, they often do not include patient, caregiver and societal costs in the calculations.…”

Section: Costs and Cost-effectiveness Of Palliative Carementioning

confidence: 99%

Integration of oncology and palliative care: a Lancet Oncology Commission

Kaasa

Loge

Aapro

et al. 2018

The Lancet Oncology

540

539

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Presence of palliative care inpatient consultation team Presence of palliative care outpatient clinic Presence of community based / home palliative care Clinical processes (*) Presence of multidisciplinary specialized palliative care team Routine symptom screening in the outpatient oncology clinic Administration of systemic cancer therapy (e.g. chemo and targeted agents) possible in patients admitted to PC service oncology-and palliative care as well as their cultures. Local variations in terms of resources and practices also probably play a role. By acknowledging integration of oncology and PC as a complex process including different parts of the health care system, both horizontally and vertically, and also involving the patient, we propose SCPs as a means for future efforts to promote integration. For the same reasons, this paper will address integration in different panels. Each panel will address different aspects of integration, ranging from how to focus on the patient, to societal changes and new research areas. Introduction of panels Policy-challenges and frameworks Societal challenges Prognostication Patient-centredness-content methodology and clinical implications Models of palliative care integration The role of education: challenges and recommendations Research The commission is an international collaboration between 30 experts in oncology, PC, public health and psycho-oncology. In October 2016 a kick-off meeting was held in Milan where panel leaders were appointed, the structure of the commission was decided, and a plan for the work was agreed upon. During the two following years each panel expanded with experts within the relevant field, conducted topical literature searches, and an interactive writing process was conducted. Both administrative and academic organization were run from Norway, by Stein Kaasa, Jon Håvard Loge and Tonje Lundeby. Policy-challenges and frameworks Questions to be addressed What type of recommendations is given for integration at the national and international level on policy and public health at present? What are the current examples of different practices in organization of palliative care in different national policies in European countries? What kind of policies and approaches are needed for integration of oncology and palliative care? Patient-centredness-content, methodology and clinical implications Questions to be addressed What is patient-centredness? What are the main elements of patient-centred care in practice? How do we involve the family? Communication-a necessary tool for patient-centred care What are the barriers and solutions to succeed? Research Questions to be addressed What are some opportunities and challenges for integrating oncology and palliative care teams to conduct research together? What are some key research priorities related to integration of palliative care and oncology? What are some key research priorities related to symptom assessment and treatment? What are some key research priorities related to psychosocial support, communication and dec...

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Cost Savings Associated With an Inpatient Palliative Care Unit: Results From the First Two Years

Abstract: Among patients who died in the hospital, transfer to a PCU is associated with significant cost savings as compared with patients on hospital wards who are seen by a PCCS.

Cited by 29 publications

References 27 publications

Impact of a New Palliative Care Program on Health System Finances: An Analysis of the Palliative Care Program Inpatient Unit and Consultations at Johns Hopkins Medical Institutions

Impact of a New Palliative Care Program on Health System Finances: An Analysis of the Palliative Care Program Inpatient Unit and Consultations at Johns Hopkins Medical Institutions

Hospital, local palliative care network and public health: how do they involve terminally ill patients?

Integration of oncology and palliative care: a Lancet Oncology Commission

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