Measuring Impact and Value
Palliative Care at UT Southwestern: Impact and Savings
Without an understanding of the cost savings that result from palliative care, it is difficult to incentivize hospitals to invest in a dedicated palliative care team. The purpose of this analysis was to measure the impact of palliative care services on hospital charges in the five days prior to death--the most expensive time of a patient's life1,2--and identify hospital service categories and patient financial classes yielding the highest savings from palliative care.
The analysis population included UT Southwestern patients admitted to the hospital between October 1, 2013, and September 30, 2016. Palliative care patients were defined as any patient who received at least one completed palliative care order. In order to create an accurate comparison group, a propensity score match was generated to identify patients most likely to have qualified for a palliative care consult. Covariates included in the model were age, sex, race, financial class, and number of comorbidities. Comorbidities were identified using the Elixhauser Comorbidity Index3, and all charges were pulled for the five days prior to death. Total hospital charges were also reported by hospital service and financial class. Statistical significance was then derived using a gamma distributed log-linked generalized linear model.
The final population included in the analysis, post the propensity score match, was comprised of mostly white, non-Hispanic males. Financial class was distributed between Medicare (48.2%) and private insurance (30.6%). The majority of the patients had ten or fewer comorbidities, and the primary pre-existing conditions seen among patients were cardiovascular diseases (36.0%) and cancer (23.4%). The hospital service categories yielding the highest mean savings were pharmacy ($2,765) and labs ($1,063). When total hospital charges were stratified financial class, charity/self-pay and Medicaid patients saved the most from palliative care services, with charity/self-pay patients saving an average of $14,148, and Medicaid patients saving an average of $12,041.
Overall, there was a significant difference in charges between those that received a palliative care consult and those that did not. The fact that the highest savings were in pharmacy and lab services suggests that unnecessary labs and medications are discontinued in an effort to improve patient care and quality of life while reducing costs during end-of-life care. There were also statistically significant differences between financial classes, with charity/self-pay patients saving the most per patient. Palliative care services ease the cost burden of end-of-life services for low income populations.
Though the primary goal of palliative care is to improve patient quality of life, palliative care can also serve as a valuable cost-saving service for hospitals and patients alike during end-of-life care.
1. Lubitz, James D., and Gerald F. Riley. "Trends in Medicare payments in the last year of life."
New England journal of medicine
328.15 (1993): 1092-1096.2. Riley, Gerald F., et al. "Medicare payments from diagnosis to death for elderly cancer patients by stage at diagnosis." Medical care 33.8 (1995): 828-841.3. Elixhauser, Anne, et al. "Comorbidity measures for use with administrative data."
36.1 (1998): 8-27.
Ashley Bird, MPH
5323 Harry Hines Blvd.
Dallas, TX, 75390
- Kelly Robinson, PharmD
- Stephanie Houck, MD
- Steven Leach, MD
- Tiffany Lawson, MBA, BSN, RN