CAPC Palliative Care Discussion Forum
Billing and Finance
I'm a graduate student finishing up my Master of Health Administration. I'm currently working with a team of colleagues on a culminating project--to design an outpatient palliative care program that functions within an existing oncology clinic at a local hospital.
We've been doing a lot of research, but are currently hung up on a couple of questions. We've seen a lot of information about the financial and satisfaction impact of inpatient palliative care programs, but haven't found nearly as much about outpatient programs. We are looking to find information about the benefits of having an outpatient palliative care program--especially financial benefits to the hospital. We would also love to see whether or not outpatient palliative care programs lead to less ER visits, fewer hospital stays, etc.
Does anyone have any ideas about where we could look to get this information? Or any experience on how you've seen outpatient palliative care impact patients?
Thank you for your help!
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Outpatient Palliative Care Program Questions
Wonderful project you are working on.
You are very much on the leading edge of where palliative care is growing in the US.
The financial implications of inpatient palliative care are clear and have been well-documented in peer-reviewed journals.
Unfortunately, it’s pretty clear that outpatient palliative care clinics will not be able to support themselves through billing revenue.
However, there are a number of individual outpatient programs that are beginning to identify the financial advantages to health care systems of outpatient palliative care (earlier referrals to hospice, avoided unnecessary/undesired interventions and hospitalizations). The financial benefits are at the scale of systems caring for a population of patients (like ACOs). These larger systems are likely the sources of sustainable support for outpatient palliative care.
As you suggest, the clinical benefits of outpatient palliative care are clear. Temel, NEJM 2010 [http://www.ncbi.nlm.nih.gov/pubmed/20818875] showed early, outpatient palliative care resulted in improved depression, better quality of life, and prolonged life for patients with lung cancer. In the Temel study, patients who got early palliative care had fewer hospitalizations and less chemotherapy at the end of life. Although the expected associated cost savings haven’t yet been fully analyzed, these kinds of results likely will be available soon.
There are a few published studies to check out now:
Cost Savings: Brumley, JPM, 2003 [http://www.ncbi.nlm.nih.gov/pubmed/14622451]
Time Saving: Muir, J Pain Sx Mgmt, 2010 [http://www.ncbi.nlm.nih.gov/pubmed/20619215]
By the way, CAPC is working to synthesize what is out there, and will be launching their next IPAL on outpatient palliative care at their November national conference. Check out the ICU and ED IPALS at http://www.capc.org/ipal.
Best,
Mike Rabow, MD
Palliative Care Leadership Center
UCSF