The Business Case for Palliative Care: Translating Research Into Program Development in the U.S.

Cassel, J. Brian; Kerr, Kathleen; Kalman, Noah S.; Smith, Thomas J.

doi:10.1016/j.jpainsymman.2015.06.013

Cited by 55 publications

(37 citation statements)

References 45 publications

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“…Introducing PC earlier in the disease course may lead to a variety of positive person‐centered outcomes, including longer survival, greater satisfaction with healthcare, and fewer symptoms and better quality of life . For the vast majority of health systems, a positive financial return needs to accompany the positive clinical effect for sustained and widespread implementation . Medicare Advantage, as in this study, health maintenance organizations, or alternative payment models such as accountable care organizations better align the “clinical case” and the “business case.”…”

Section: Discussionmentioning

confidence: 91%

“…In Medicare Advantage plans, the payer and the provider shared the financial risk for overuse of hospital care, rather than the payer alone, as is the case in fee‐for‐service or traditional Medicare. In this context, Sharp HealthCare invested resources to change the treatment of individuals, aligning a person‐centered PC approach with financial exposure . Among other things, the Sharp program encourages referring providers to identify individuals who are likely to start using the hospital to manage their disease process.…”

Section: Discussionmentioning

confidence: 99%

“…The program focuses on Medicare Advantage beneficiaries seen in medical groups affiliated with Sharp Healthcare, for which Sharp is at full risk for hospital costs. Under such a payment mechanism, the clinical and business imperatives for earlier, proactive PC involvement are aligned . The program has been open to Pioneer accountable care organization and Medicare fee‐for‐service beneficiaries, but those populations have not widely used it, and this study focused on the Medicare Advantage beneficiaries and the costs of care for which Sharp was at full risk.…”

Section: Program Descriptionmentioning

confidence: 99%

See 2 more Smart Citations

Effect of a Home‐Based Palliative Care Program on Healthcare Use and Costs

Cassel¹,

Kerr

McClish³

et al. 2016

J American Geriatrics Society

Self Cite

126

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ObjectivesTo evaluate the nonclinical outcomes of a proactive palliative care program funded and operated by a health system for Medicare Advantage plan beneficiaries.DesignObservational, retrospective study using propensity‐based matching.SettingA health system in southern California.ParticipantsIndividuals who received the intervention between 2007 and 2014 (n = 368) were matched with 1,075 comparison individuals within each of four disease groups: cancer, chronic obstructive pulmonary disease, heart failure, and dementia. All were known to be dead at the time of the retrospective study, were Medicare Advantage beneficiaries, and had 2 years of usage data before death. Median age at death for each disease group was older than 80.InterventionHome‐ and clinic‐based palliative care (PC) services provided by a multidisciplinary team.MeasurementsOutcomes included hospital costs, other healthcare costs, readmission rates, hospital admissions and bed days, intensive care unit use in final 30 days of life, and death within 30 days of an admission.ResultsIntervention participants in all four disease groups had less hospital use and lower hospital costs nonintervention participants, which drove lower overall healthcare costs. In the final 6 months of life, healthcare costs for the intervention groups stayed largely the same from month to month, whereas costs for comparison participants increased dramatically.ConclusionIn the context of an alternative payment model in which the provider was “at risk” of bearing the costs of care, a proactive PC program helped to avoid the escalation in hospital use and costs commonly seen in the final months of life.

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Program Descriptionmentioning

confidence: 99%

See 1 more Smart Citation

Effect of a Home‐Based Palliative Care Program on Healthcare Use and Costs

Cassel¹,

Kerr

McClish³

et al. 2016

J American Geriatrics Society

Self Cite

126

View full text Add to dashboard Cite

show abstract

“…It is not clear how the use of palliative care consultation teams affects insurance expenditures, since the extent to which reduced hospital costs are passed on to payers varies by reimbursement system. [44] Palliative care provided early in a hospitalization may change the procedures performed and thus the Medicare Severity Diagnosis-Related Group, which could result in lower expenditures by Medicare (or other case-rate payers) for that case than would otherwise have been required.…”

Section: Policy Implicationsmentioning

confidence: 99%

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

et al. 2016

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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.

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“…Whereas most studies have performed their cost-minimization analyses on the basis of clinical trial data, few have used administrative data that are available at most hospitals to estimate the total impact of a PC program on health system savings. 19 In this study, we documented the financial impact of a PC program for a large academic health medical center, the Johns Hopkins Medical Institutions (JHMI). The cost analysis considers three components of this PC program, using administrative data: PCU costs, PC consultation costs (for patients in other inpatient units), and professional fees income.…”

Section: Real-life Implicationsmentioning

confidence: 99%

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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The Business Case for Palliative Care: Translating Research Into Program Development in the U.S.

Cited by 55 publications

References 45 publications

Effect of a Home‐Based Palliative Care Program on Healthcare Use and Costs

Effect of a Home‐Based Palliative Care Program on Healthcare Use and Costs

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

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

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