Home-Based Palliative Care for seriously ill patients is often better and costs Less than hospitalization

Categories: Research.
  • Authors conclude that patients in their final months of life have more of their needs met in a home-based program compared to hospitalization.
  • Home-based palliative care resulted in reduced costs of $12,000 per patient in comparison to those getting care in a hospital in the final three months of life. 

Home-based palliative care was associated with significant reductions in total Medicare cost, fewer hospital admissions and an increase in hospice utilization in the final months of life. Described by the authors as important research for public policy implications, the study showed a 34 percent reduction in hospital admissions in the patients’ final months. The cost per patient during the final three months of life was $12,000 lower with home-based palliative care than for usual care. Approximately 90 percent of patients in the program were able to die at home, consistent with the expressed desires of the vast majority of people.

The authors believe the study provides strong evidence that patients obtain a better quality of life and have their needs better met when they stay out of the hospital. “Less hospitalization in the final month of life is important. Typically, hospitals are associated with more burdens, suffering, loneliness and stress,” says Dr. Dana Lustbader, a study co-author.

The sickest five percent of patients in the United States account for 50 percent of costs, with the largest portion spent in the final months of life, generally for inpatient care.[1] Over the past decade, hospital-based palliative care teams have demonstrated improved outcomes and cost savings.[2][3][4] To date, little has been reported on the economic impact of home-based palliative care programs.[5] Home-based care is important since hospitals may accelerate functional decline for those with advanced illness.[6]  

Clear-cut research was needed to examine cost and outcome metrics for home-based palliative care — and to show if that service model could result in better care coordination and high quality end-of-life care.  

The study, titled “The Impact of a Home-Based Palliative Care Program in an Accountable Care Organization,” was performed by ProHEALTH, a large multi-specialty physician provider group in New York that is a part of the national health care delivery organization, OptumCare. Dr. Lustbader, chairman of the Department of Palliative Medicine at ProHEALTH, led a 16-person study team.  A control group was used for comparison purposes during the 18-month study period.

The study will be presented at the Accountable Care Organization World Congress this month in Washington DC and also at the national conference for the Center to Advanced Palliative Care in Orlando this month.

The study was a retrospective analysis to quantify cost savings associated with a home-based palliative care in a Medicare Shared Savings Program ACO where total cost of care is available. The researchers studied 651 decedents; 82 enrolled in a home-based palliative care program compared to 569 receiving usual care in three New York counties who died between October 1, 2014, and March 31, 2016. The researchers also compared hospital admissions, ER visits, and hospice utilization rates in the final months of life.

[1]Institute of Medicine: Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life. Report Brief. 2015. Washington, DC: The National Academies Press. www.nap.edu/read/18748/chapter/1 (Last accessed July 16, 2016).

[2]May P, Normand C, Morrison RS: Economic impact of hospital inpatient palliative care consultation: Review of current evidence and directions for future research. J Palliat Med 2014;17:1054–1063.

[3]Smith TJ, Cassel JB: Cost and non-clinical outcomes of palliative care. J Pain Symptom Manage 2009;38:32–44

[4] Morrison RS, Dietrich J, Ladwig S, et al.: Palliative care consultation teams cut hospital costs for Medicaid beneficiaries. Health Aff (Millwood) 2011;30:454–463.

[5]Rabow M, Kvale E, Barbour L, et al.: Moving upstream: A review of the evidence of the impact of outpatient palliative care. J Palliat Med 2013;12:1540–1549.

[6]Gill TM, Gahbauer EA, Han L, et al.: The role of intervening hospital admissions on trajectories of disability in the last year of life: Prospective cohort study of older people. BMJ 2015;350:h2361.

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