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CAPC Palliative Care Discussion Forum
Billing and Finance

Next Reply: Re:Hospital cost avoidance
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Post Hospital cost avoidance
Author: palliate1
Date: Feb 17, 2010 4:44 pm
We are a new palliative care consult service. We are struggling with the hospital finance people on how to best calculate cost aviodance when our intervention quickly results in either withdrawal of life-prolonging care resulting in death or quickly results in hospice admission and discharge to a nearby free-standing hospice care center. In these cases, some of which have been in intensive care for weeks, the disposition is fast enough that we have none or few post-consult days to demonstate decreased costs. These are intuitively, the cases with the greatest cost avoidance, but it's unclear how much cost avoidance to credit. How do others handle this?
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Re:Hospital cost avoidance (by lhspragens on 02/26/2010)
You have well articulated the dilemma. There are several strategies that will help:
1) Gather baseline data (before you started) re LOS and outliers on a given unit or diagnosis group - be as targeted as possible. Then if you launch a pilot or focused initiative to improve care for that group, you should be able to pick up some impact. This may require use of distribution charts and stratification, vs. simple means and medians.
2) Gather testimonials and document them immediately when you think it is likely you made a big difference. For example, when the unit nurse says, "I thought that this would go on for weeks; we couldn't get anywhere with the family.." and you all were able to craft consensus and a transfer - capture that! If every month you have 2-3 of these as short cases, you have data that can be translated into value.
3) discuss your proposed methods with leadership, ask for their perspective on value and what to measure (and what they want you to be focusing upon), and ask for data support prospectively.
4) Track the increase in hospice referrals and also ask the hospice to track the LOS of the referrals coming from your team vs all others - over time you may see the LOS increase, which has value to the hospice; this can build partnership support - but only if you ask, partner, and agree on shared goals.
5) Summary: value, like beauty, is in the eye of the beholder - find out what matters up front and establish measures to keep you on track to meet that.

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