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Rethinking Palliative Care & Hospitalist Medicine: The CCA Experience

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Presentation on theme: "Rethinking Palliative Care & Hospitalist Medicine: The CCA Experience"— Presentation transcript:

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!


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