Palliative care cuts hospitalization costs

Quality of life improved as well, study says

A study published recently in Health Affairs shows that hospitalization costs for patients with certain terminal or serious chronic illnesses are significantly lower when palliative care is provided. In fact, the study of four hospitals in New York State showed an average cost of admission that was $6,900 lower for these patients.1 Compared to another group of patients who received more traditional care, they were less likely to die in the ICU, did not spend as much time in intensive care, and were more likely to receive hospice referrals. The authors also asserted that the state's Medicaid program could save between $84 million and $252 million annually if every hospital in the state that had at least 150 beds implemented a palliative care program.1

"We based our selection criteria on patients typically cared for by palliative teams as described in the literature," notes lead author R. Sean Morrison, MD, director, National Palliative Care Research Center, Hermann Merkin Professor of Palliative Care, Professor of Geriatrics and Medicine, and vice-chair for Research in the Brookdale Department of Geriatrics and Palliative Medicine at Mount Sinai School of Medicine in New York City. "We looked at advanced cancer, cancer that had spread beyond the primary organ, patients with advanced heart and lung disease who had had one or more hospitalization, patients living with AIDS with one or more complication of the disease, and patients who had spent a long period of time in the ICU."

How could such savings be possible simply with the use of palliative care? "The key is that the palliative care teams identify patient values and goals for their care and selectively match treatment to those goals," says Morrison. "When you look at the [Medicaid] population, it involves 5%-10% of the most complex, seriously ill patients. Hospitals are not designed to take care of them well; they're designed to care for the average person."

This, he points out, is a complete mismatch. "What palliative care teams do is align the mismatch; we make the hospital a better environment for the patient."

When you do a cost-benefit analysis of such a program, he continues, the choice becomes even clearer. "For the average 300-bed hospital, the program would include a physician, a nurse practitioner, a social worker, a chaplain, and typically some administrative support," he says. "That typically runs about $750,000 a year, while the average savings to a hospital range between $4 million and $5 million a year."

Palliative care teams, he adds, are in place in about 80% of mid-sized and large hospitals, and in 60% of hospitals overall.

Improving quality of life

Morrison notes that even when financial considerations are not factored in, palliative care offers significant benefits. "They focus on improving quality of life for patients living with serious or life-threatening illnesses," he says. "They address pain, so the patients feel better; they provide intensive communication about goals with the patient and family; and they help them navigate a complex health system."

In some sets of patients, he continues, palliative care has been shown to prolong survival — especially when connected with curative treatments. "It's very important it be done at the same time as life-prolonging or curative treatment," he says. "There are some patients who may live a long time with serious illness."

Morrison says he had already demonstrated the benefits of palliative care for non-Medicaid patients. "We did that study two years ago; we looked at five hospitals throughout the U.S., predominantly Medicare patients. The savings were even greater."2

This makes sense, he says. "When you look at Medicare and private pay, those patients are much more likely to have a primary care physician who can oversee their care; Medicaid patients often fall through the cracks," he explains.

References

1. Morrison RS, Dietrich J, Ladwig S, et al. Palliative care consultation teams cut hospital costs for medicaid beneficiaries. Health Affairs 2011;30:454-463.

2. Morrison RS, Penrod JD, Cassel BJ, et al. Cost savings associated with US hospital palliative care con-sultation programs. Arch Intern Med 2008;168:1783-1790.

Sources

For more information about the cost benefit of palliative care, contact:

R. Sean Morrison, MD, Director, National Palliative Care Research Center, Hermann Merkin Professor of Palliative Care, Professor of Geriatrics and Medicine, Vice-Chair for Research, Brookdale Department of Geriatrics and Palliative Medicine, Box 1070, Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, NY 10029. Tel: (212) 241-1466; fax: (212) 860-9737; e-mail: sean.morrison@mssm.edu.