Home-based palliative care within an accountable care organization (ACO) was associated with significant cost savings, fewer hospitalizations, and increased hospice use in the final months of life, found a recent study.1
“The motivation for our study was to evaluate the outcomes and cost of providing a specially trained team of nurses, social workers, and doctors to care for people with advanced illness in their home with 24/7 availability,” says lead author Dana Lustbader, MD, FAAHPM. Lustbader is chair of the department of palliative medicine at ProHEALTH in Lake Success, NY, and professor of clinical medicine at Hofstra Northwell School of Medicine.
The researchers expected that a team approach to caring for frail elderly patients, or those with advanced illness, would result in improved quality of life, fewer symptoms, and less distress.
“What surprised us most was that better care cost significantly less — $12,000 less than usual care,” says Lustbader. “That was astounding.”
The vast majority (87%) of patients who died did so in their homes, compared to only 24% of those receiving usual care without palliative care. “Most people want to be at home when they are at the end of life, and not in a hospital or ICU,” says Lustbader. “Palliative care is not only what most seriously ill people want, but costs significantly less.”
Unfortunately, the current healthcare system financially rewards high care intensity, hospital admissions, and medical treatments, says Lustbader.
“Most people with advanced illness want access to care where they live — in their homes, when they can no longer get to the doctor’s office, or when symptoms develop during off hours,” says Lustbader. People with advanced illness often go to the ER or hospital when their disease progresses or they develop distressing symptoms. “This is burdensome, costly, and often dangerous, as these patients can get worse by being hospitalized,” says Lustbader.
Focus On Quality Measures
Physician Quality Reporting System (PQRS) was implemented as part of healthcare’s shift toward a value-based reimbursement system. Failure of providers to submit PQRS data can result in a reimbursement penalty up to 4%.
“Currently, PQRS measures do not align with palliative care services,” says Janet Bull, MD, MBA, FAAHPM, HMDC, chief medical officer at Four Seasons Compassion for Life in Flat Rock, NC. Bull is lead author of a paper which gave palliative care providers assistance in deciding how to report and what measures to report.2
The quality measures focus on symptom assessment, pain improvement, and advance care planning. Bull says collecting PQRS data will enable benchmarking with other providers and help define benchmarks.
“As the country moves toward a value-based reimbursement system, it is important to show value in palliative care,” she concludes.
Lustbader points to evidence that seriously ill people can live longer, with better quality of life, when offered palliative care teams who provide care at home.
“The moral imperative is that all people with advanced illness and their loved ones should have access to palliative care and health plans should pay for it — period, end of story,” says Lustbader.
- Lustbader D, Mudra M, Romano C, et al. The impact of a home-based palliative care program in an accountable care organization. J Palliat Med 2016 Aug 30. [Epub ahead of print].
- Bull J, Kamal AH, Jones C et al. Top 10 tips about the Physician Quality Reporting System for palliative care professionals. Journal of Palliative Medicine 2016; 19(8):806-813.
- Janet Bull, MD, MBA, FAAHPM, HMDC, Chief Medical Officer, Four Seasons Compassion for Life, Flat Rock, NC. Phone: (828) 233-0302. Fax: (828) 692-2365.
- Dana Lustbader, MD, FAAHPM, Chair, Department of Palliative Medicine, ProHEALTH, Lake Success, NY/Professor of Medicine, Hofstra Northwell School of Medicine. Email: DanaLustbader@iCloud.com.