Palliative Care Consultation Teams Cut Hospital Costs For Medicaid Beneficiaries

Abstract

Patients facing serious or life-threatening illnesses account for a disproportionately large share of Medicaid spending. We examined 2004-07 data to determine the effect on hospital costs of palliative care team consultations for patients enrolled in Medicaid at four New York State hospitals. On average, patients who received palliative care incurred $6,900 less in hospital costs during a given admission than a matched group of patients who received usual care. These reductions included $4,098 in hospital costs per admission for patients discharged alive, and $7,563 for patients who died in the hospital. Consistent with the goals of a majority of patients and their families, palliative care recipients spent less time in intensive care, were less likely to die in intensive care units, and were more likely to receive hospice referrals than the matched usual care patients. We estimate that the reductions in Medicaid hospital spending in New York State could eventually range from $84 million to $252 million annually (assuming that 2 percent and 6 percent of Medicaid patients discharged from the hospital received palliative care, respectively), if every hospital with 150 or more beds had a fully operational palliative care consultation team.

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

“…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.…”

Living With Advanced Illness: Longitudinal Study of Patient, Family, and Caregiver Needs

“…10,[23][24][25][26][27][28][29][30][31] Increased median longevity was observed among patients with small-cell lung cancer in early referral outpatient palliative care settings versus usual care. 32 Patients provided with inpatient palliative care consults were less likely to die in intensive care units and more likely to receive hospice referrals.…”

“…32 Patients provided with inpatient palliative care consults were less likely to die in intensive care units and more likely to receive hospice referrals. 25 Consults in outpatient and inpatient settings can improve pain management, symptoms, quality of life, depression, and anxiety. 32,33 …”

Projected Costs of Informal Caregiving for Cardiovascular Disease: 2015 to 2035: A Policy Statement From the American Heart Association

“…111 By determining patient and caregiver goals of care through skilled communication, treating distressing symptoms while coordinating care, providing practical support for patients and caregivers, and mobilizing community support and resources to ensure a secure and safe living environment, palliative care teams help meet patient and caregiver needs so that they can avoid unwanted and expensive crisis care. [112][113][114] Many large US hospitals now have palliative care services, but availability across settings is highly variable by region and by state. Only a small fraction of the patients and families who could benefit receive it.…”