Palliative Care and Medicaid

Eric Widera at GeriPal blog reporting on a new study by Sean Morrison and others showing that hospital based palliative care services reduce Medicaid costs.

Results of this study were via Eric:

• Patients receiving palliative care consultations had on average a $6,900 reduction in hospital costs per admission.
• Patients who were discharged alive and received palliative care had an average decrease in hospital costs of $4,098 per admission
• Patients who died in the hospital and received palliative care had an average decrease in hospital costs of $7,563.

The study like most in this field couldn't relate detailed measures of quality to the cost of care, though patients receiving palliative care were less likely to die in an intensive care unit and had fewer days in the hospital. Patients had a variety of primary diseases, were insured by Medicaid only, and had a hospital stay of 4 days or longer.

I need to read the study closely, but palliative care continues to be shown to be advantageous to costs in a variety of settings and to improve quality. However, I think more work remains to be done to more precisely document the relationship between length of use of palliative care of all types (hospice as well as non hospice palliative care) and quality of care. In policy terms this is very important, because it goes to the issue of how important it is to extend length of hospice use from the 25th percentile of 5 days to the median of around 20 days. There is evidence that such an increase will reduce costs, but it is not clear how much such an increase will improve quality. This detail helps determine how important such expansions are from the patient perspective.

I have a new grant funded by the HCFO Initiative at RWJ Foundation along with Amy Abernethy at Duke that will investigate this question in a prospective manner, looking at both hospice and non hospice palliative care in conjunction with Janet Bull and colleagues at Four Seasons. More on this soon.