Cost Savings from Palliative Care Teams and Guidance for a Financially Viable Palliative Care Program

AbstractObjective:Due to multiple issues, integrated interdisciplinary palliative care teams in a neonatal intensive care unit (NICU) may be difficult to access, sometimes fail to be implemented, or provide inconsistent or poorly coordinated care. When implementing an effective institution-specific neonatal palliative care program, it is critical to include stakeholders from the clinical, operational, and financial worlds of healthcare. In this study, researchers sought to gain a multidisciplinary perspective into issues that may impact the implementation of a formal neonatal palliative care program at a tertiary regional academic medical center.Method:In this focused ethnography, the primary researcher conducted semistructured interviews that explored the perspectives of healthcare administrators, finance officers, and clinicians about neonatal palliative care. The perspectives of 39 study participants informed the identification of institutional, financial, and clinical issues that impact the implementation of neonatal palliative care services at the medical center and the planning process for a formal palliative care program on behalf of neonates and their families.Results:Healthcare professionals described experiences that influenced their views on neonatal palliative care. Key themes included: (a) uniqueness of neonatal palliative care, (b) communication and conflict among providers, (c) policy and protocol discrepancies, and (d) lack of administrative support.Significance of results:The present study highlighted several areas that are challenging in the provision of neonatal palliative care. Our findings underscored the importance of recognizing and procuring resources needed simultaneously from the clinical, operational, and financial worlds in order to implement and sustain a successful neonatal palliative care program.

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UT Southwestern’s Palliative Care Program: Measurable Patient Impact and Cost-savings

Journal of Pain & Palliative Care Pharmacotherapy ◽

10.1080/15360288.2019.1624675 ◽

2018 ◽

Vol 32 (4) ◽

pp. 212-215

Author(s):

Ashley Bird ◽

Steven Leach ◽

Stephanie Houck ◽

Kelly Robinson ◽

Tiffany Lawson

Keyword(s):

Palliative Care ◽

Cost Savings ◽

Care Program ◽

Palliative Care Program

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Filling the Gap: Creating an Outpatient Palliative Care Program in Your Institution

American Society of Clinical Oncology Educational Book ◽

10.1200/edbk_200775 ◽

2018 ◽

pp. 111-121 ◽

Cited By ~ 7

Author(s):

Esme Finlay ◽

Michael W. Rabow ◽

Mary K. Buss

Keyword(s):

Palliative Care ◽

Symptom Burden ◽

Cost Savings ◽

Care Program ◽

Business Case ◽

Health Care Use ◽

Palliative Care Program ◽

Care Clinic ◽

Advantages And Disadvantages ◽

Institutional Values

Well-designed, randomized trials demonstrate that outpatient palliative care improves symptom burden and quality of life (QOL) while it reduces unnecessary health care use in patients with cancer. Despite the strong evidence of benefit and ASCO recommendations, implementation of outpatient palliative care, especially in community oncology settings, faces considerable hurdles. This article, which is based on published literature and expert opinion, presents practical strategies to help oncologists make a strong clinical and fiscal case for outpatient palliative care. This article outlines key considerations for how to build an outpatient palliative care program in an institution by (1) defining the scope and benefits; (2) identifying strategies to overcome common barriers to integration of outpatient palliative care into cancer care; (3) outlining a business case; (4) describing successful models of outpatient palliative care; and (5) examining important factors in design and operation of a palliative care clinic. The advantages and disadvantages of different delivery models (e.g., embedded vs. independent) and different methods of referral (triggered vs. physician discretion) are reviewed. Strategies to make the case for outpatient palliative care that align with institutional values and/or are supported by local institutional data on cost savings are included.

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Commentary: Is there a model for demonstrating a beneficial financial impact of initiating a palliative care program by an existing hospice program?

Palliative & Supportive Care ◽

10.1017/s1478951504040568 ◽

2004 ◽

Vol 2 (4) ◽

pp. 419-423 ◽

Cited By ~ 5

Author(s):

STEVEN D. PASSIK ◽

CAROL RUGGLES ◽

GRETCHEN BROWN ◽

JANET SNAPP ◽

SUSAN SWINFORD ◽

...

Keyword(s):

Palliative Care ◽

Medical Center ◽

Academic Medical Center ◽

Cost Savings ◽

Care Program ◽

Palliative Care Program ◽

Potential Cost ◽

Physician Visits ◽

Financial Benefits ◽

Simple Models

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?

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