Palliative care programs may lead to significant cost savings, study finds

Hospital palliative care consultation teams are associated with cost savings of up to $374 per patient per day and $1.3 million annually for the typical community hospital, according to a study published in yesterday’s Archives of Internal Medicine. The study is among the first large-scale analyses to document cost savings linked to palliative care programs, which seek to identify early in treatment what patients and family members seek from therapy and have been associated with reduced health care utilization and improved care for seriously ill adults, according to the study authors.

The data suggest that palliative care “fundamentally shifts the course of care off the usual hospital pathway” and substantially reduces costs “by establishing clear treatment goals, reviewing current treatments to establish their concordance with these goals, and recommending and legitimizing discontinuation of treatments or tests that do not meet established goals.” According to the authors, the findings provide strong financial incentives for hospitals and lawmakers to develop and expand palliative care programs, particularly as patients with medically complex illnesses account for a growing proportion of admissions

Morrison et al., Archives of Internal Medicine, Abstract

Background

Hospital palliative care consultation teams have been shown to improve care for adults with serious illness. This study examined the effect of palliative care teams on hospital costs.

Methods

We analyzed administrative data from 8 hospitals with established palliative care programs for the years 2002 through 2004. Patients receiving palliative care were matched by propensity score to patients receiving usual care. Generalized linear models were estimated for costs per admission and per hospital day.

Results

Of the 2966 palliative care patients who were discharged alive, 2630 palliative care patients (89%) were matched to 18 427 usual care patients, and of the 2388 palliative care patients who died, 2278 (95%) were matched to 2124 usual care patients. The palliative care patients who were discharged alive had an adjusted net savings of $1696 in direct costs per admission (P = .004) and $279 in direct costs per day (P < .001) including significant reductions in laboratory and intensive care unit costs compared with usual care patients. The palliative care patients who died had an adjusted net savings of $4908 in direct costs per admission (P = .003) and $374 in direct costs per day (P < .001) including significant reductions in pharmacy, laboratory, and intensive care unit costs compared with usual care patients. Two confirmatory analyses were performed. Including mean costs per day before palliative care and before a comparable reference day for usual care patients in the propensity score models resulted in similar results. Estimating costs for palliative care patients assuming that they did not receive palliative care resulted in projected costs that were not significantly different from usual care costs.

Conclusion

Hospital palliative care consultation teams are associated with significant hospital cost savings.

R. Sean Morrison, MD; Joan D. Penrod, PhD; J. Brian Cassel, PhD; Melissa Caust-Ellenbogen, MS; Ann Litke, MFA; Lynn Spragens, MBA; Diane E. Meier, MD; for the Palliative Care Leadership Centers' Outcomes Group

(Morrison et al., Archives of Internal Medicine , 9/8 [subscription required]; Gever, MedPage Today , 9/8; Steenhuysen, Reuters , 9/8). (SOURCE: Advisory Board Daily Briefing , www.advisory.com, October 23, 2004)