1. Rethinking Palliative Care & Hospitalist Medicine: The CCA Experience
John Loughnane, MD
Medical Director – CCA Life Choices and Inpatient Medicine at Boston Medical Center

2. Agenda Description of our programs
Where we stand today – results interpreted
Where we need to go
Q & A

3. Palliative – Life Choices Program
Started September 2009
“End of Life Care is Normative Care”
Transitioning from a hospice model of care
Interventions:
Widespread education programs
Direct consultations both live and virtual
Integration into BMC hospital service
Partnerships with community resources
Flexible thinking development

4. End of Life / Palliative Care Initiative Impact
Indicator
Pre Project Implementation Baseline Time Period
Baseline
Benchmark
Ultimate Performance Goal
2009
2010
2011
Dying at home
% or members dying at home
CY 2009
19%
45%
>45%
29.6%
37%
ICU days at end of life
Average # of ICU days per decedent in last 6 months of life
2.72 days
2 days
< 2 days
1.49 days
1.53 days
Advance care planning
% of members with evidence of advance care planning in medical record
CY 2008
56%
90%
>90%
67%
59%
74%
Medical Costs PMPM in Last 6 months of Life (CCACG-East)
$10,146 NA
$6,370
$7,528

5. The Fundamental Problem, as Posed by a Known Man of Letters
“I don't want to achieve immortality through my work... I want to achieve it through not dying.”
“I am not afraid of death, I just don't want to be there when it happens.”

6. CCA BMC Inpatient Service
Pilot begun June 2010 as extension of outpatient model
Attending hospitalist and NP/PA team CCA focused
Partner with Boston Medical Center Family Practice on development of new model of inpatient care
Specific interventions
Daily contact with outpatient teams
Consult and follow off service patients
Integration of outpatient palliative care
Coordinated inpatient meetings with outpatient providers as needed
Diversion from emergency room to home or other care

7. CCA Inpatient Model of Care – Preliminary Results for CCA BMC Pilot
Year
Total # adm
Adm/1000
30 day readm
Avg cost
Disch
home
Obs adm
CY 2011
171
357
19.9%
$11,585
76%
19.3%
Q1 & 60
232
8.3%
$9,596
85%
33.8%

8. Preliminary Comparison of CCA on/off Inpatient Pilot Program – Q1 & 2 2012
Site
Total # adm
Adm/1000
30 day readm
Avg cost
Disch
Home
Obs Adm
Off service 90
453
24.4%
$11,172
63%
16.5%
On service 60
232
8.3%
$9,596
85%
33.8%

9. What’s Next?
“Marinating” progress in an ever changing inpatient environment.
Increased diversion from ER with development of community partners
Creating a “core” of MDs, NPs, PAs who understand and buy into the system
Grow volume, increase financial viability
Growth to other services, hospitals
Results!