Despite the cost effectiveness, insurers typically don't reimburse for palliative care services beyond doctor visits and care related to hospitals. Current healthcare reform proposals include consultation reimbursements.
Michael Nisco, MD, MBA, medical director of the 436-licensed-bed Saint Agnes Medical Center's hospice and palliative care program in Fresno, Calif., says, "We get more testimonials from patients and families in tremendous distress that palliative care reduces stress on the patient, the family, the nurse, the physician. This is an understanding of what can and can't be done for a patient, and it is savings in the long run. This is patient-centered care."
Saint Agnes Medical Center has grown over the past five years with an average of 120 new inpatient referrals each month to an average of more than 400 total patient contacts, including follow-ups each month, according to the hospital.
Many healthcare systems are still evaluating their ROI for palliative care programs, which are relatively new.
At the 230-staffed-bed Gundersen Lutheran Hospital in LaCrosse, Wis., the palliative care program has shown improved fiscal performance and has resulted in "significantly reduced hospital costs," according to the hospital. In a 2008 report, the hospital cited a cost reduction of $3,500 per patient in billed costs, and a reduction of hospital readmissions for palliative care patients to 6%, compared to 18% in a control population. In addition, the hospital report cited "higher ratings of satisfaction with care from families of patients who die in the hospital."
In an extensive study in 2006, the Sutter Health Institute for Research and Education, part of Sutter Health in San Francisco, found that palliative care programs at 798-bed California Pacific Medical Center in that city resulted in estimated annual savings of $2.2 million, with daily costs for palliative care patients 14.5% lower compared to usual care patients.
Experts foresee potential for new palliative care programs across the nation. About 90 million Americans are living with serious and life-threatening illnesses, a number that is expected to double in the next 25 years, according to the Center to Advance Palliative Care. The organization's observation is that most people with serious illness experience inadequate and fragmented care from a variety of doctors. Communication is another issue the organization identifies as problematic, both between doctor and patient, and among the patient's medical caregivers.
Success key No. 1: Expanding into outpatient
Gundersen Lutheran Hospital has initiated a pilot program with the Centers for Medicare & Medicaid Services that enables prospective patients and their families to consider outpatient palliative care—even before they are admitted to the hospital.
"Our goal is to try to enroll patients much earlier, identifying them much earlier in their care," says Bernard Hammes, PhD, director of Respecting Choices, an organization owned and operated by Gundersen Lutheran that assists organizations and communities in implementing advance care planning practices. He also is Gundersen's director of medical humanities and chairs its institutional review board and ethics committee.
Essentially, the hospital works with patients and their families to integrate patient choices and direction before a time when the patients can't make their own medical decisions. Afflicted with complicated illnesses, these patients have progressive diseases that could result in functional decline and frequent hospitalizations and emergency department visits. Many patients' prognosis gives them two years or less to live—with the anticipation of continuous decline during those two years. Gundersen Lutheran's program features an interdisciplinary care team dedicated to providing high-quality, seamless medical care, individualized for each patient and his or her family.