Palliative Care Teams’ Cost-Saving Effect Is Larger For Cancer Patients With Higher Numbers Of Comorbidities

Abstract

Patients with multiple serious conditions account for a high proportion of health care spending. Such spending is projected to continue to grow substantially because of increased insurance eligibility, the ever-rising cost of care, the continued use of nonbeneficial high-intensity treatments at the end of life, and demographic changes. We evaluated the impact of palliative care consultation on hospital costs for adults with advanced cancer, excluding those with dementia. We found that compared to usual care, the receipt of a palliative care consultation within two days of admission was associated with 22 percent lower costs for patients with a comorbidity score of 2–3 and with 32 percent lower costs for those with a score of 4 or higher. Earlier consultation was also found to be systematically associated with a larger cost-saving effect for all subsamples defined by multimorbidity. Given ongoing workforce shortages, targeting early specialist palliative care to hospitalized patients with advanced cancer and higher numbers of serious concurrent conditions could improve care while complementing strategies to curb the growth of health spending.

Life-Sustaining Procedures, Palliative Care, and Cost Trends in Dying COPD Patients in U.S. Hospitals: 2005~2014

“…We apply higher inflation rate using the CMS' measurement of hospital care compared to the inflation rate using the Consumer Price Index (CPI) for medical care available from the U.S. Bureau of Labor Statistics (49). We observe the cost-saving effect of palliative care as seen in previous cost analysis studies (15,18,50), but we add the findings of a cost-increase effect of LSTs. The magnitude of cost-increases from LSTs (systematic procedures 59.0%; local procedures 72.0%; surgeries 55.2%) exceeded the cost-saving effect of palliative care (-28.7%); therefore, annual hospital cost increased by 5.81% in our study.…”

“…It has been shown that a hospital-based palliative care service leads to positive patient satisfaction, fewer hospital admissions and in-hospital deaths, less invasive EOL treatments, or fewer hospital expenditures, all of which in turn promote quality of life (13)(14)(15)(16)(17)(18)(19). The physical and psychological needs of COPD patients during EOL are equivalent or exceed those experienced by patients with other chronic illnesses (8,(20)(21)(22).…”

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

“…[6][7][8][9][10][14][15][16]22 Definitions of the financial terms are given in the Appendix (online only). The Johns Hopkins Institutional Review Board approved this study.…”

Few Hospital Palliative Care Programs Meet National Staffing Recommendations

“…20 Bundled payment reimbursement could increase the use of palliative care because of its demonstrated cost savings. [7][8][9][10][11][12][13][14] CMS and private insurers should also explore reimbursing providers for telehealth consultations, which could facilitate access to specialty-level palliative care in programs that do not have physicians and in rural and other safetynet settings. 32,33 Health system managers have a responsibility to ensure that palliative care is available and of high quality.…”

“…1,6 Growth in palliative care programs has been driven in part by evidence that palliative care improves patient outcomes and satisfaction, while reducing costs associated with intensive medical care. 1,[7][8][9][10][11][12][13][14] Palliative care can be provided in settings throughout the continuum of care, but the predominant model in the United States (outside of hospice care) is the hospital consultative team model. 3 Central to this model are interprofessional teams, which can include physicians, advanced practice and other registered nurses, social workers, chaplains, pharmacists, rehabilitation therapists, direct care workers, and other clinical and nonclinical specialists.…”