Palliative Care Reduces Hospital Costs by Over $3K Per Patient

May 11, 2018 - Hospitals costs fell by an average of $3,237 per patient when providers added prompt palliative care to routine treatments during the course of a hospital stay, reported researchers from the Icahn School of Medicine at Mount Sinai and Trinity College Dublin in a new JAMA Internal Medicine study.

“People with serious and complex medical illness account heavily for healthcare spending, yet often experience poor outcomes,” explained the study’s lead author, Peter May, MD, Research Fellow in Health Economics at the Centre for Health Policy and Management, Trinity College Dublin.

“The news that palliative care can significantly improve patient experience by reducing unnecessary, unwanted, and burdensome procedures, while ensuring that patients are cared for in the setting of their choice, is highly encouraging. It suggests that we can improve outcomes and curb costs even for those with serious illness.”

Palliative care provides patients suffering from life-limiting, complex illnesses with pain and symptom management, communication of care options before and after discharge, and patient-centered guidance with treatment options.

Despite its potential to ease patient concerns and better treat terminally ill patients, hospitals have yet to integrate palliative care into routine care delivery. About one-quarter of Medicare beneficiaries die in acute care hospitals, and a significant portion of these patients undergo expensive, intensive healthcare services in the last weeks of life, a 2013 JAMA study showed.

Limited palliative care use in acute hospitals adds to the already high costs of patients with serious and complex illnesses, May et al. stated.

“Costs are increasing because of not only increasing prevalence of serious chronic disease but also increasing unit costs of medical care, including hospital care,” they wrote. “Reforming a system originally designed to provide acute, episodic care is essential for its long-term sustainability.”

Prompt palliative care during a hospital stay has the potential to significantly reduce hospital costs while enhancing the patient experience, especially for patients with life-limiting cancer diagnoses, uncovered the meta-analysis of six studies involving over 130,000 individuals admitted to US hospitals between 2001 and 2015.

Hospital costs fell $4,251 per patient with a cancer diagnosis per hospital stay when providers delivered palliative care within three days of admission.

For patients receiving palliative care without a cancer diagnosis, hospital costs decreased $2,105 per hospital stay.

“We hypothesized that this estimated association would be greater for patients with primary diagnosis of cancer than those with a primary noncancer diagnosis because inpatients with cancer are typically receiving more aggressive care that palliative care may be more able to influence,” researchers explained.

Researchers also validated their hypothesis that patients with more comorbidities would realize greater hospital cost savings when they received timely palliative care.

Patients with four or comorbidities saw significantly greater savings through palliative care versus patients with two or fewer comorbidities, the analysis showed. The same held true for patients with the two comorbidities versus those with one to no comorbidities.

The greater savings among medically complex patients may have stemmed from palliative care having “a greater change in treatments for patients with complex needs (e.g., polypharmacy) than for those for whom single disease-focused treatment remains appropriate,” the researchers posited.

Researchers intend for the study’s findings to promote greater use of palliative care in the hospital setting.

“The potential to reduce the suffering of millions of Americans is enormous,” concluded study co-author R. Sean Morrison, MD, Ellen and Howard C. Katz Chair at the Brookdale Department of Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mount Sinai. “This study proves that better care can go hand in hand with a better bottom line.”