COST: Palliative Care Savings Measured

We've known that a palliative care team in the hospital can improve care for seriously ill adults, but there's been less consensus on whether it also saves money. A new study concludes it does—an average of $300 per patient per day.

The paper in the Sept. 8th edition of the Archives of Internal Medicine by Dr. Sean Morrison of the Mt Sinai Hospital and the Center to Advance Palliative Care and colleagues matched palliative care patients to "usual care" patients. The palliative care patients who were discharged alive had an adjusted net savings of $1,696 in direct costs per admission, or $279 per day. Amongst those who died, the adjusted net savings were higher, $4,908 per admission, and $374 per day. The savings came from reductions in laboratory work, intensive care cost (and for the patients who died, pharmaceuticals.) The team checked to make sure that the savings could be attributed to palliative care, not to a clinical course of action already determined before the palliative care team got involved with the case.

These findings don't come as a surprise to me, because I've visited several palliative care teams and watched them in action. Granted, I've been to some of the top ones in the country (Mt. Sinai, Dartmouth, George Washington, Virginia Commonwealth, San Diego's Moores Cancer Center among them) and what I've seen has by definition been anecdotal. But the more I've seen, the more doctors and nurses and chaplains and social workers and patients and families I've met, the more I have become convinced that palliative care is one of the elements we need to strengthen in our health care system if we are to improve care coordination, quality, and cost.

Palliative care isn't the same as hospice—not all patients are dying, and not all patients needing palliative care give up treating the underlying disease, as is usually the case with hospice. Nor is palliative care about rationing, or about dictating to families what choices they should make. It's about controlling pain and symptoms, providing support, and taking the time to make sure that families understand what's really going on, what their options really mean, what treatment choices match the patient's values, desires and wishes. Watching palliative care teams at work often left me in tears... but what struck me is how often I saw the members of the team—doctors, nurses, social workers, chaplains—also brush away tears.

Most, although not all, of the team members believed that their work, although time-consuming and labor-intensive, made economic sense as well. Now they have some numbers to back them up. That should help them persuade hospital administrators to sustain or expand such programs, and I hope it helps health reformers at both the state and national level next year to see palliative care as a valuable tool for helping patients live out their final days as they choose, in as much comfort as possible, while making sure we are using health care resources in a sustainable and sensible way.