The value of integrating palliative with curative modes of care
earlier in the course of disease for people with life threatening
illnesses is well recognized. Whereas the now outdated model of waiting
for people to be actively dying before initiating palliative care has been
clearly discredited on clinical grounds, how a better integration of modes
of care can be achieved, financed and sustained is an ongoing challenge
for the health care system in general as well as for specific
institutions. When the initiative comes from a hospital or academic
medical center, which may, for example, begin a palliative care
consultation service, financial benefits have been well documented. These
palliative care services survive mainly by tracking cost savings that can
be realized in a number of ways around a medical center. We tried to pilot
3 simple models of potential cost savings afforded to hospice by
initiating a palliative care program. We found that simple models cannot
capture this benefit (if it in fact exists). By adding palliative care,
hospice, while no doubt improving and streamlining care, is also taking on
more complex patients (higher drug costs, shorter length of stay, more
outpatient, emergency room and physician visits). Indeed, the hospice was
absorbing the losses associated with having the palliative care program.
We suggest that an avenue for future exploration is whether partnering
between hospitals and hospice programs can defray some of the costs
incurred by the palliative care program (that might otherwise be passed on
to hospice) in anticipation of cost savings. We end with a series of
questions: Are there financial benefits? Can they be modeled and
quantified? Is this a dilemma for hospice programs wanting to improve the
quality of care but who are not able on their own to finance it?
Cost Savings from Palliative Care Teams and Guidance for a Financially Viable Palliative Care Program
