Cost Savings Vary by Length of Stay for Inpatients Receiving Palliative Care Consultation Services

Abstract

Background: Cost savings associated with palliative care (PC) consultation have been demonstrated for total hospital costs and daily costs after PC involvement. This analysis adds another approach by examining costs stratified by hospital length of stay (LOS). Objective: To examine cost savings for patients who receive PC consultations during short, medium, and long hospitalizations. Methods: Data were analyzed for 1815 PC patients and 1790 comparison patients from two academic medical centers between 2005 and 2008, matched on discharge disposition, LOS category, and propensity for a PC consultation. We used generalized linear models and regression analysis to compare cost differences for LOS of 1 to 7 days (38% of consults), 8 to 30 days (48%), and > 30 days (14%). Comparisons were done for all patients in both hospitals (n = 3605) and by discharge disposition: survivors (n = 2226) and decedents (n = 1379); analyses were repeated for each hospital. Results: Significant savings per admission were associated with shorter LOS: For stays of 1 to 7 days, costs were lower for all PC patients by 13% ($2141), and for survivors by 19.1% ($2946). For stays of 8 to 30 days, costs were lower for all PC patients by 4.9% ($2870), and for survivors by 6% ($2487). Extrapolating the per admission cost across the PC patient groups with lower costs, these programs saved about $1.46 million for LOS under a week and about $2.5 million for LOS of 8 to 30 days. Patients with stays > 30 days showed no differences in costs, perhaps due to preferences for more aggressive care for those who stay in the hospital more than a month. Conclusion: Cost savings due to PC are realized for short and medium LOS but not stays > 30 days. These findings suggest savings can be achieved by earlier involvement of palliative care, and support screening efforts to identify patients who can benefit from PC services early in an admission.

Costs and readmission rates for the resection of primary and metastatic spinal tumors: a comparative analysis of 181 patients

“…The complications and length of stay have been robustly shown to be associated with an increase in hospitalization cost across many subspecialties of medicine 35,36,42 and in the surgical management of spinal tumors. 34,41 Our study further supports these findings.…”

Facilitating Palliative Care Referrals in the Intensive Care Unit

“…Palliative care involvement positively impacts the use of resources by limiting or stopping undesired and/or unsuccessful aggressive treatment, while continuing to support the patient-identified goals of care. 12,[21][22][23][24][25][26] For these patients, interdisciplinary interventions typically include review of current issues and treatment options, pain and symptom management, emotional and spiritual support, goal-of-care conversations, and discharge planning. 8 Palliative care teams promote shared decision making, reduce ICU use at end of life, and ease the emotional burdens of families.…”

“…Of particular note is a retrospective study conducted by Starks et al, 25 which examined cost savings stratified by length of stay (LOS) and discharge disposition (n = 3605). Data were gathered in 2 academic medical centers between 2005 and 2008.…”

A Hospice-Hospital Partnership: Reducing Hospitalization Costs and 30-Day Readmissions among Seriously Ill Adults

“…T here is a growing evidence base supporting the observation that inpatient palliative care (IPC) consultation services reduce length of stay (LOS) and hospital costs [1][2][3][4][5][6][7] while concurrently increasing patient and provider satisfaction, 8,9 improving symptom control, 10 and increasing advance directive completion. 11,12 In addition, studies have shown that IPC services reduce the likelihood of intensive care unit (ICU) readmission.…”