The Lynx Group

Palliative Care Program Eases Patient Symptoms and Hospital Costs

November 2016, Vol 7, No 10

San Francisco, CA—In addition to improving quality of care and patient satisfaction, palliative care can also save hospitals millions of dollars, according to a study presented by lead investigator Sarina Isenberg, PhD candidate, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. The study’s final analysis showed that expanded patient access to palliative care demonstrated substantial savings to the Johns Hopkins Hospital and Health System and could lead to approximately $20 million in savings in 5 years, said Ms Isenberg at the 2016 Palliative Care in Oncology Symposium.

“Combined inpatient and consult palliative care programs contribute to substantially lower charges and costs per day. There is also accumulating evidence that palliative care programs reduce disparities in end-of-life care,” she said.

Systemwide Expansion in Palliative Care

In fall 2017, Johns Hopkins Medicine will increase the size of its palliative care inpatient unit from 6 beds to 11 beds, and will improve inpatient palliative care consultation capacity across its system. In addition, the updated palliative care unit will receive direct admissions from the emergency department, along with transfers from other departments.

Based on data from fiscal year 2015, Ms Isenberg and colleagues demonstrated a $444 daily reduction in costs for the 6-bed palliative care unit compared with hospital inpatient stays before transfers to the palliative unit. The cost-savings for an 11-bed unit operating at 80% occupancy, assuming that the occupancy rate would rise by 2.5% annually to 85% by fiscal year 2021, would triple the total capacity.

Expanding to an 11-bed unit would yield savings of $6.7 million over 5 years (ie, $444 daily × 3009 days annually, or approximately $1.3 million annually). According to Ms Isenberg and colleagues, these savings are primarily attributed to avoiding hospital admissions during the last 30 to 45 days of life. The projected financial impact of increased palliative care consultation capacity was even greater.

For palliative care consults of 785 alive discharges (ie, $2197 per case) and 97 decedent discharges (ie, $6357 per case), total estimated savings in direct costs were found to be $2,530,000 annually, or $12,650,000 over 5 years.

These savings would result from “reductions in lab and intensive care unit costs, compared with usual care patients,” the investigators noted.

When cost-savings for the palliative care unit and palliative care consulting were combined, total savings were $3,866,000 annually, and $19,330,000 over 5 years.

As significant as these numbers are, the proposed expansion is about more than just savings, Ms Isenberg emphasized.

“The palliative care unit allows for additional benefits not calculated in this analysis, including inpatient backfill opportunities, more appropriate ICU [intensive care unit] bed use, savings from increased referral to hospice, the opportunity for increased revenue from improved patient satisfaction scores, reduced readmission rates, philanthropy, research opportunities, and goodwill,” she concluded.

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