Hospital charges for a community inpatient palliative care program

Abstract

Defining financial parameters of palliative care (PC) is important for providing sustainable programming. In our study, we evaluated hospital length of stay (LOS) and charges for the first 164 inpatient PC consultations performed by the Advanced Illness Assistance (AIA) team at Blount Memorial Hospital (BMH). These AIA patients had a median LOS of 11 days (range, 3-114 days), mean total charges per patient of 65,795 dollars, and mean daily charges of 3,809 dollars. Higher mean daily charges (p = 2.74 E-08, chi-square) were associated with patients who received consultation because of nonphysical symptom reasons. Patients were followed in PC consultation (AIA follow-up days) for a median of five days (range, 1-48), and had mean daily charges of 3,117 dollars. These mean daily charges were 414 dollars less than the charges for the five days prior to PC consultation (pre-AIA days) (p = 0.04, t-test). There was a significant decrease in laboratory and imaging charges during AIA follow-up (p = 0.04, t-test). The study included a reference group of patients whose information was obtained retrospectively from the BMH Atlas (MediQual, Marlborough, MA) database. These reference group patients were hospitalized at BMH during the same time, but they were not seen by the AIA team. The reference group was matched by Diagnosis Related Group (DRG), Admission Severity Grade (ASG), and disposition to the AIA patients. The Atlas patients had a shorter median LOS of six days (range, 1-105 days), and significantly greater mean daily charges of 4,105 dollars (p = 0.006, t-test) compared with AIA patients. Mean daily charges decreased for Atlas patients, as their day of discharge approached (p < 0.001). Estimates of potential charge savings were calculated in two ways: 1) by evaluating the effect of decreasing the LOS of Atlas patients with long LOS (more than seven days) to the level of AIA patients with long LOS, and 2) by comparing the actual mean patient charges during AIA follow-up with using the pre-AIA mean daily charges during the AIA follow-up period and correcting for the effect of decreasing charges that occurred as discharge approached. The estimated savings achieved by decreasing long LOS were more than 100,000 dollars per year, and estimated savings achieved using AIA follow-up charges were more than 1,801,930 dollars per year.

Economic Impact of Hospital Inpatient Palliative Care Consultation: Review of Current Evidence and Directions for Future Research

“…24,25,28,29,31 The three studies that stratify by survivors and decedents report consistently higher costs for patients who died but an inconsistent treatment effect on costs between the two groups; two studies find similar differences in proportional savings (11%-20%) with slightly higher treatment impact for decedents 29,31 ; the other reports a large discrepancy with a 5% cost-saving from palliative care for survivors and 31% for decedents. 33 Of the two studies reporting hospital charges, one reported mean daily charges around 7% lower for palliative care 23 and the other median total charges around 16% lower for palliative care. 26 The only study to take a postdischarge health costs perspective finds costs for palliative patients 32% lower than those for usual care patients over 6 months.…”

“…27 While there is variation in terms of hospital type and the label given to multidisciplinary teams, the composition of those teams are broadly consistent. Six of the 10 evaluations were described as comprising at least a physician, a nurse, a social worker, and a chaplain [23][24][25][26][27][28] ; in some cases these were also described as including a psychologist and/or an oncology nurse specialist and/or nursing assistants. Of the other 4, 2 were multisite studies in which all teams included a physician and nurse but not all included a social worker and chaplain, 29,31 and another assessed a newly implemented service that initially comprised a physician and nurse before later incorporating a chaplain.…”

“…29 Nine of the studies restrict their perspective to the hospital and do not evaluate patient or caregiver outcomes. [23][24][25][26][28][29][30][31]33 The remaining article analyzes total health care costs for 6 months postdischarge as well as some patient outcome measures but does not quantify the relationship between the two. 27 While there is variation in terms of hospital type and the label given to multidisciplinary teams, the composition of those teams are broadly consistent.…”

“…Observational designs dominate with 9 cohort studies [23][24][25][26][28][29][30][31]33 and 1 randomized controlled trial. 27 Among observational studies there is a wide variation in size with 5 having intervention groups of between 27 and 164 patients, [23][24][25][26]28 and 1 study having 4908 intervention patients. 29 Nine of the studies restrict their perspective to the hospital and do not evaluate patient or caregiver outcomes.…”

Content Validation of a Novel Screening Tool to Identify Emergency Department Patients With Significant Palliative Care Needs

“…Many high-quality studies, including several randomized trials, [6][7][8] have examined the benefits of PC and shown it leads to significant improvements in patient quality of life and mood, 9 increased patient and caregiver satisfaction, 3,10,11 reduction in health care costs, [12][13][14] decreased intensive care unit (ICU) days, [15][16][17][18] hospital length of stay, physical symptomatology, and improved resource usage. 19 Despite the clear benefits of PC, the vast majority of patients who could benefit from PC are never identified or referred at any point during the course of their illness.…”