Having an effective end-of-life care strategy can improve total cost of care for a health system while also driving improvements in care quality and patient satisfaction.
Better integration of hospice and palliative care is an important part of the broader effort to contain costs. One study from the Journal of Palliative Medicine found that cost per admission for patients receiving inpatient palliative care was $1,401 less on average than for comparison patients, and another study from Health Affairs similarly found that each admission of a patient to hospice care 53-105 days before death saved Medicare $2,561, on average. These savings are particularly pronounced among patients receiving catastrophic care. One 2014 study from JAMA, for example, found that patients with poor prognosis for cancer who leveraged hospice services incurred nearly $8,700 less in costs than those who did not. The slow but steady march toward value-based care, which is expected to accelerate in the current political environment, will enhance the benefit of investing in areas such as hospice.
As hospital reimbursement becomes increasingly tied to quality, shifting appropriate patients to hospice can also help hospitals by taking the risk out of applying certain quality metrics and by influencing a broader segment of the care continuum. One study estimated that seriously ill adults discharged to hospice have a hospital readmission rate of 5%, relative to 13% for those discharged to home health and 24% for those discharged to a nursing home.
Coordination with a hospice can help triage patients in real time to determine whether hospital admission is appropriate. For example, MedStar Mobile Healthcare (an ambulance service in Texas) partnered with Vitas (a national hospice provider) and reduced unnecessary ambulance transports by dispatching Vitas staff to the home of hospice beneficiaries when a 911 call was initiated, to evaluate the situation. Beyond hospital readmissions, well-coordinated hospice services can help reduce intensive care unit (ICU) admissions and utilization. According to a 2014 study from Critical Care Medicine, hospice transfers saved 585 ICU bed days per year.
Common characteristics of systems that have successfully launched a hospice care offering include high inpatient utilization, home healthcare delivery capabilities, high patient volume, adoption of VBC and/or a provider-sponsored health plan, and physician interest and buy-in (Figure 4).