The estimated hospital-wide financial impact of a comprehensive inpatient palliative care (PC) program.

173 Background: Inpatient PC improves quality of care, patient and family satisfaction, and lowers costs. PC consultation during a cancer hospital stay led to a 14 (if by day 6) to 24% (by day 2) reduction in direct cost, and especially when people had comorbidities. (May, JCO 2015; Health Affairs 2016). We attempted to discern the financial impact of both a PC inpatient unit (PCU) and PC consultations on patients in other inpatient units for a large academic medical center, the Johns Hopkins Hospital (JHH), as we prepared to expand the PCU from 6 to11 beds and increased inpatient PC consultation capacity.

METHODS: We estimated the savings for an 11 bed PCU based on cost per day from FY 2015 with a 6 bed unit ($444 lower costs per PCU day compared to inpatient stay prior to transfer to the PCU). We then calculated the cost savings for an 11 bed unit operating at 80% occupancy. We estimated the direct cost savings of consultations by adjusting the $/discharge saved (Morrison, Arch Int Med 2008) to 2014 $ (by multiplying the $/discharge saved by 1.4 to adjust for medical inflation).

RESULTS: The PCU inpatient stays resulted in projected lower costs of $6.7M over 5 years ($444/day x 3009 days/year, or $~1.3M yearly). IP revenue and margins were small (data not shown). For PC consults of 785 alive discharges ($2197/case) and 97 decedent discharges ($6357/case), total estimated savings in direct costs per case are $2,530,000/year. The PCU allows for additional benefits not calculated in this analysis, including inpatient backfill opportunities, more appropriate ICU bed use, savings from increased referral to hospice (hospice referrals increased 340% in 3 years), and reduced readmission rates from increased PC and hospice use.

CONCLUSIONS: In addition to improving quality of care and patient satisfaction, the combined IP and consult PC programs contribute to substantially lower charges and costs per day. Backfill revenue, the opportunity for increased revenue from improved patient satisfaction (HCAHPS) scores, and reduced readmission rates will increase this financial impact. [Table: see text].