A Hospice-Hospital Partnership: Reducing Hospitalization Costs and 30-Day Readmissions among Seriously Ill Adults

John C. Tangeman, MD, FACP,¹ Carole B. Rudra, PhD, MPH,² Christopher W. Kerr, MD, PhD,¹ and Pei C. Grant, PhD¹

¹Center for Hospice and Palliative Care, Cheektowaga, New York.

²Rudra Research, LLC, Buffalo, New York.

Address correspondence to:

Pei C. Grant, PhD

Center for Hospice and Palliative Care

225 Como Park Boulevard

Cheektowaga, NY 14227

E-mail: pgrant@palliativecare.org

Accepted March 9, 2014

ABSTRACT

Background: Inpatient palliative care (IPC) has been associated with numerous clinical benefits. Observational and randomized studies of cost savings associated with IPC provide conflicting results, and the association with readmission is not well understood.

Objective: We aimed to estimate the influence of IPC on hospitalization costs and readmission rates.

Methods: We measured hospitalization costs and 30-day readmission rates among 1004 patients who received IPC at two western New York hospitals in 2012. Using propensity score matching, we compared outcomes among patients receiving palliative care with those among 1004 similar adults who were hospitalized during the same period and did not receive palliative care.

Results: On average, cost per admission was $1,401 (13%) lower among patients receiving palliative care than comparison patients (p<0.05). Cost reductions were evident within intensive care and laboratory services. Readmission rates were significantly lower among palliative care patients discharged with hospice care (1.1%) than comparison patients (6.6%), but significantly higher among palliative care patients discharged to other locations (12.1%).

Conclusions: Receipt of IPC appears to reduce hospitalization costs among adult western New Yorkers. Furthermore, care coordinated with postdischarge hospice services appears to substantially reduce the likelihood of readmission.