1. Palliative Care Cost : A look at the evidence
Stephen R. Connor, PhD
International Palliative Care Consultant, IPCI
Senior Executive, Worldwide Palliative Care Alliance

2. Palliative Care in Practice
Controls pain and symptoms
Facilitates communication and decisions about goals of care with patient and family
Interdisciplinary, multi-dimensional care
Coordinates care and transitions across fragmented medical system
Provides education & practical support for family caregivers
Use clinical examples!
Talk about why you went into it – Mr. Santana
Talk about what you do every day.

3. Value Proposition
Palliative Care (PC) reduces unnecessary health care services
Palliative care lowers costs (for hospitals and payers) by reducing hospital and ICU length of stay, ER use, and direct pharmacy and diagnostic costs.
Home based care, complex case management, with after hours access
Cost impact vs. cost effectiveness

4. Care Management Focuses on the Needs of Patients
100 90 80 70 60 50 40 30 20 10 %
Patients
Cost per
Patient
Management
Approach
Patient Type
Worried well
Self-resolving illness
Low grade acute illness
Demand
Management
Low
Chronic diseases
Moderate to severe acute illness
Disease
Management
Medium
Complex Patients
Significant diagnosis
Multiple co-morbidities
Often terminal
Several providers of care
Psychological / social / financial upheaval
Case
Management
Complex Care
Management
High

6. US Studies on Hospice/Palliative Care Cost Impact
Kidder (1992) ($1.26 saved per $1.00)
Congressional Budget Office ($1.52 saved)
Pyenson, Connor, et al (2004) Study
Campbell et al (2004) Study
Taylor, et al (Duke, 2007) Study
Morrison et al (2008)

7. Hospice reduces Medicare expenses $1.26 for every $1.00 spent
Selection issues

8. 14 of 16 diagnoses saved $1097 - $8935/admit
Prostate and stroke more cost for hospice

9. Decreased cost for cancer but not for non-cancer
Propensity adjustment not matched for length of hospice use

10. Propensity adjustment based on hospice use
Hospice use reduced Medicare program expenditures during the last year of life by an average of $2309 per hospice user
The maximum reduction in Medicare expenditures per user was about $7000, which occurred when a decedent had a primary condition of cancer and used a hospice for their last 58–103 days of life.
For other primary conditions, the maximum savings of around $3500 occurred when a hospice was used for the last 50–108 days of life

11. Live discharge savings $1696/admission
Deceased savings $4908/admission

12. Palliative Care and Costs
Live Discharges
Hospital Deaths
Costs
Usual Care
Palliative Care Δ
Per Day $ $
$ *
$ 1,484
$ 1,110
$ 374*
Per Admission
$11,140
$ 9,445
$ 1,696**
$22,674
$17,765
$4,908**
Laboratory
$ 1,227 $
$ *
$ 2,765
$ 1,838
$ 926*
ICU
$ 7,096
$ 1,917
$ 5,178*
$14,542
$ 7,929
$7,776*
Pharmacy
$ 2,190
$ 2,001 $
$ 5,625
$ 4,081
$1,544***
Imaging $ $
($58)***
$ 1,673
$ 1,540
$ 133
Died in ICU X
18% 4%
14%*
*P<.001 **P<.01 ***P<.05
Morrison RS et al. Arch Intern Med 2008; 168:1783

13. Consistent Findings
Dying (complex care) patients most expensive in health care systems
Overall savings for palliative care vs. usual care
Maximal savings if hospice care 1-3 months
Though early intervention is key
Savings for both cancer and non-cancer, but more for cancer