Home-Based Palliative Care Program Found to Reduce Costs, Hospital Admissions

A home-based palliative care (HBPC) program tested within an accountable care organization (ACO) demonstrated substantial cost savings and reduced hospital admissions for patients near the end of life, according to a Journal of Palliative Medicine study.

The study authors examined outcomes after the implementation of an HBPC program within a Medicare Shared Savings Programs (MSSP). The study focused on 651 patients in a New York metropolitan area MSSP who died between October 1, 2014, and March 31, 2016—569 died while in usual care, and 82 were enrolled in the HBPC program.

Patients eligible for the ProHEALTH Care Support HBPC program were often homebound and elderly, suffering from chronic diseases like advanced heart failure, metastatic cancer, or dementia. The ProHEALTH team consisted of 6 registered nurses, 2 social workers, 2 doctors, 1 data analyst, 3 administrative staff, and 12 volunteers who visited patients in their homes. Its model differed from the usual model of care in that it focused on 24/7 coverage, team-based care, telemedicine, and specialty-level palliative care.

Statistical analyses of cost, hospital admissions, and hospice utilization all indicated significantly improved outcomes for the patients in HBPC. During the final 3 months of life, the cost per patient—measured as spending on Medicare Parts A, B, and D—was $20,420 for HBPC. This cost represented a savings of $12,000 from the $32,420 spent during this period for each patient receiving usual care. These savings were driven by a 35% reduction in Part A and 37% reduction in Part B spending during the HBPC patients’ final 3 months of life.

Hospital admissions were reduced by 34% for HBPC patients in their final month of life, and emergency department visits decreased as well. HBPC participants had a 35% higher hospice utilization rate and a higher median length of hospice stay at 34 days compared to 10 days for patients with usual care.

Another striking statistic was the 45% reduction in cost for HBPC patients in their final month of life. The study authors noted that this was likely due to their 87% rate of death at home compared to the 24% of Medicare beneficiaries who die at home nationwide each year. This increased likelihood of dying at home rather than in a hospital is related to the patient-centered decision making that is a cornerstone of the HBPC program. Social workers and nurses held conversations about goals of care, including hospitalization and resuscitation preferences, with the patients during home visits.

Proponents of HBPC models have pointed to this improved quality of care and life in conjunction with the cost savings as proof of palliative care’s potential as part of ACOs. “Providing access to palliative care to the sickest 2% of the 55.3 million Medicare beneficiaries in the United States could result in better outcomes at substantially lower cost,” said the authors in the study. “The perfect alignment of quality and financial outcomes in an ACO provides a unique opportunity to support HBPC.”