Hospital Palliative Care Impact Calculator

Palliative care increases patient and family satisfaction and improves quality of care.[1] Building high-impact palliative care programs requires matching resources and program investment with strategic priorities. The Hospital Palliative Care Impact Calculator can help you plan your inpatient consult service by providing an estimate of expected hospital savings attributable to your palliative care team.

Input Values

How it Works

Timely palliative care consultation impacts inpatient hospital costs. A 2018 meta-analysis demonstrated palliative care consultations conducted within three days of hospital admission were associated with a $3,237 reduction in direct hospital costs per patient (2015 inflation-adjusted dollars).[2] These cost savings, however, do not reflect the cost of the palliative care team staff or other long-term benefits, such as decreased hospital utilization after discharge.

Projected savings are reductions in direct hospital costs for Medicare Part A services. Palliative care team direct costs are likely to be reported as professional services expenses, and projected billing revenue is from Medicare Part B for professional services. Calculations assume that a team has a specialty-trained interdisciplinary staff to provide timely care for complex patients, including sufficient follow-ups. Cost savings will vary by institution due to variations in cost structures, team composition, payer mix, and patient mix.

To estimate cost savings, the Impact Calculator uses the data you provide, the 2018 meta-analysis, and representative estimates of staff costs and billing revenue. This tool also contains data comparing your program to hundreds of others on the proportion of hospital admissions receiving a palliative care consult (the program’s “penetration rate”) and team staffing. This can be used to evaluate your program in relation to your peers, and help you plan forward.

Frequently Asked Questions

After you enter your data, look at Section 2 to see where your current statistics place your program. What quartile are you in for staffing? For penetration? Are they reasonably matched, or are they two quartiles apart? Consider using Section 1 and doing a three-year version, projecting staffing and volume for the next two years. What quartile are you in each year? How do your costs change? Your impact or savings? How can you use this to discuss and prioritize the use of your team, and focus on specific patient populations or performance metrics such as “time from admission to consult”? This provides perspective and comparative data. Use the calculations to help you plan specific local actions.

You can estimate annual admissions using the following shortcut:

[(Staffed Beds x 365 days) * Average Occupancy Rate] / Average Length of Stay = Estimate of Admissions

See Section 5, Estimates of Direct Cost Savings for Inpatient Palliative Care Consult Services, for additional detail. The $3,237 per case savings (May et al, 2018) is a statistically significant reduction in direct costs from an analysis of more than 133,000 cases of patients with and without palliative care. It is based on well-developed palliative care programs providing consultations completed within the first three days of hospital admission. This was an important characteristic to be able to compare the direct cost of the total inpatient stay to the cost of a patient without palliative care.

The Impact Calculator helps demonstrate the likely impact of cost savings related to patient volume and investment in services. These savings are spread across numerous cost budgets in the hospital. Look at the difference between cost savings per patient and staffing costs per patient in Section 1. Savings should significantly exceed costs and provide a basis for discussions about current and future budget investments to maintain quality care. The data in Section 2 should help you see how your program compares to others in patient volume and staff size, to also help plan forward.

CAPC members have access to recurring Virtual Office Hours on demonstrating value through measurement, and tools and technical assistance on financing, demonstrating value, and making the case for palliative care.

Citations

  1. ↩ Ahluwalia SC, Chen C, Raaen L, et al. A Systemic Review in Support of the National Consensus Project Clinical Practice Guidelines for Quality Palliative Care, Fourth Edition. J Pain Symptom Manage. 2018 Dec;56(6):831-870. doi:10.1016/j.jpainsymman.2018.09.008.
  2. ↩ May P, Normand C, Cassel JB, et al. Economics of Palliative Care for Hospitalized Adults with Serious Illness: A Meta-analysis. JAMA Intern Med. 2018 Jun 1;178(6):820-829. doi:10.1001/jamainternmed.2018.0750.

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