Palliative Care Consultation Teams Cut Hospital Costs For Medicaid Beneficiaries

Department of Geriatrics and Palliative Medicine, Mount Sinai School of Medicine, New York City, NY, USA.
Health Affairs (Impact Factor: 4.97). 03/2011; 30(3):454-63. DOI: 10.1377/hlthaff.2010.0929
Source: PubMed


Patients facing serious or life-threatening illnesses account for a disproportionately large share of Medicaid spending. We examined 2004-07 data to determine the effect on hospital costs of palliative care team consultations for patients enrolled in Medicaid at four New York State hospitals. On average, patients who received palliative care incurred $6,900 less in hospital costs during a given admission than a matched group of patients who received usual care. These reductions included $4,098 in hospital costs per admission for patients discharged alive, and $7,563 for patients who died in the hospital. Consistent with the goals of a majority of patients and their families, palliative care recipients spent less time in intensive care, were less likely to die in intensive care units, and were more likely to receive hospice referrals than the matched usual care patients. We estimate that the reductions in Medicaid hospital spending in New York State could eventually range from $84 million to $252 million annually (assuming that 2 percent and 6 percent of Medicaid patients discharged from the hospital received palliative care, respectively), if every hospital with 150 or more beds had a fully operational palliative care consultation team.

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    • "Palliative care is an approach to care with defined skills and knowledge that increases patient and family member satisfaction [17], reduces pain [18] and other symptoms but also reduces hospital admissions [19], costs and length of stay [20] and may increase length of life [21,22] Research shows that emphasis on the “unit of care” as being both patient and their identified family can positively impact patient and family member satisfaction with the emotional and spiritual support provided by their health care team at the very end of life, even if they are not receiving care on a specialized palliative unit [15,23,24]. "
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    • "Many factors have contributed to the development of this public health mandate including the aging demographic (Kinsella & He, 2008), the epidemiology of disease with the growing prevalence of chronic illness, and the burdens on family caregivers (World Health Organization, 2004; Raveis, 2004). The last 10 years have seen a marked growth in palliative care programs in the United States, especially hospital-based programs (Connor, 2007–2008; Morrison, Maroney- Galin, Kralovec, & Meier, 2005; Morrisson et al., 2008), and good evidence that hospitals are achieving cost savings and improvements in care outcomes by introducing palliative care teams (Morrison et al., 2005, 2008, 2011; Smith et al., 2003), although a recent state-by-state survey demonstrates that about 40% of hospitals still do not have palliative care programs (Morrison & Meier, 2011). Growth in hospital-based palliative care is crucial to improving access and relieving pain and suffering at the end of life for the frail elderly, many of whom are receiving acute care services during the last year of life (Morrison et al., 2005; Zhang et al., 2009). "
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    ABSTRACT: Health reform in the United States must address both access to medical services and universal insurance coverage, as well as health care cost containment. Uncontrolled health care costs will undermine improvements in access and coverage in the long-run, and will also be detrimental to other important social programs and goals. Accordingly, the authors offer an ethical perspective on health care cost control in the context of end-of-life and palliative care, an area considered by many to be a principal candidate for cost containment. However, the policy and ethical challenges may be more difficult in end-of-life care than in other areas of medicine. Here we discuss barriers to developing high quality, cost effective, and beneficial end-of-life care, and barriers to maintaining a system of decision making that respects the wishes and values of dying patients, their families, and caregivers. The authors also consider improvements in present policy and practice-such as increased timely access and referral to hospice and palliative care; improved organizational incentives and cultural attitudes to reduce the use of ineffective treatments; and improved communication among health professionals, patients, and families in the end-of-life care planning and decision-making process.
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