CAPC Palliative Care Discussion Forum
Hospital and Hospice Partnerships
I have a growing Palliative Program at a tertiary care, university hospital. We have inpatient and outpatient services and have had good success in securing referral patterns and initial funding for the program.
We have excellent relationships with a number of independent hospices including one in which I have served as medical director for several years. Our hospital does not have a formal hospice affiliation or unit.
Any ideas as to how we could gather support for the palliative program through a more formal affiliation with a hospice perhaps for an inpatient unit.
I see this as a win-win for all players as the hospital would receive the financial support, death rates would decline, and prolonged hospitalizations, where appropriate, could get the hospice services if needed. This would be a "game-changer" for the hospice as well as referrals are pretty competetive right now. I do not know if there is some provision limiting exclusivity of referrals from the hospital.
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Partnerships
There is published data that show not a whole lot of benefit and some risk.
Palliat Support Care. 2004 Dec;2(4):419-23.
Is there a model for demonstrating a beneficial financial impact of initiating a palliative care program by an existing hospice program?
Passik SD, Ruggles C, Brown G, Snapp J, Swinford S, Gutgsell T, Kirsh KL.
Memorial Sloan-Kettering Cancer Center, 1242 Second Avenue, New York, New York 10021, USA. passiks@mskcc.org
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 Whereas the now outdated model of waiting for people to be actively dying before initiating palliative care has been clearly discredited on clinical grounds, how a better integration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?