Hospital Palliative Care Impact Calculator Results
Outcome Summary
1.
Summary of Estimated Financial Impact: Direct Cost Savings
Review the following tables to more fully understand the data and assumptions that were used in this estimate. This data is representative of likely results, but for illustration only. Your results will vary based on the characteristics of your health system, including location, prevailing salary rates, demographics of your patients, program stage of development, and effectiveness of your team. It assumes sufficient staffing and appropriate training to meet patient need. Staffing ratios at some hospitals will be higher than modeled here, due to hospital size or characteristics (such as teaching status and patient populations). Please use this to help estimate results, but not as a substitute for good accounting and data collection of your own.
2.
Penetration Rate and Staffing: Your Program vs. National Comparisons
| Penetration Quartile | Hospital Inpatient Service Penetration Ranges | Median Penetration Rate (Initial Consults / Inpatient Hospital Admissions) | Median IDT FTEs per 10,000 Admissions* |
|---|---|---|---|
| Quartile 1 (Lowest Penetration Group) | (0.1 - 3.5%) | 2.9% | 1.5 |
| Quartile 2 | (3.6 - 4.9%) | 4.3% | 2.1 |
| Quartile 3 | (5.0 - 6.9%) | 5.8% | 2.5 |
| Quartile 4 (Highest Penetration Group) | (7.0 - 19.0%) | 9.1% | 3.6 |
| Overall Median | 5.0% | 2.3 | |
| Your Program | 8.0% | 0.0 | |
Higher penetration rates are associated with higher staffing.[1] Programs with sufficient staffing are able to provide consistent and timely responses to consult requests, as well as build relationships with referring providers. Over the past two decades, staffing has increased to accommodate patient need. The comparative data provided in this section is from the National Palliative Care Registry™ (2008-2020) for data year 2018. Participants included palliative care programs that were understaffed, so the data presented represents the current state of staffing levels rather than an ideal. We recommend planning for staffing in the top quartile (Quartile 4) to deliver timely and effective care. New programs may fall in the lowest group (Quartile 1), and may move through quartiles as the program matures. It is important to balance staffing levels with patient volume as your program grows.
*IDT FTE per 10,000 Admissions: the ratio of hospital-based palliative care interdisciplinary staffing FTE per 10,000 hospital admissions. This metric standardizes your staffing to show what your staffing would be if your hospital had 10,000 admissions. This makes it easier to compare your staffing to those from other palliative care programs. [Calculation: (Total IDT FTE x 10,000) / Total Annual Hospital Admissions]
Data Sources
Sections 3, 4, and 5 explain assumptions in Section 1 for billing, average FTE costs, and cost savings per case. They are for reference only and are not affected by the data entered in the calculator.
3
Average Cost Per FTE Based on a Sample of IDT Staffing Mix
Staffing costs are a function of FTEs, mix of disciplines, and salary and benefit rates. Salary rates are placeholder estimates. FTE mix matches results from the National Palliative Care Registry for IDT staffing. FTE weighting is based on programs reporting a complete interdisciplinary team (at least one physician, advanced practice registered nurse or registered nurse, social worker, and chaplain),[2] based on recommendations from the National Consensus Project for Quality Palliative Care Clinical Practice Guidelines for Quality Palliative Care, 4th edition.
4
Estimated Billing Revenue Per Episode of Care
Based on 2023 CMS rates for the national average.
Billing revenue will vary based upon geographic region, billing practices, and the makeup of your team. The coding mix below is a representative sample for modeling purposes only. Additional revenue from use of extended time codes and/or advance care planning codes is not included.
Hospitals will need to evaluate their overall (average) net revenue (blend of Medicare, Medicaid, Commercial, and self pay). For these estimates, we have assumed 100% collection of Medicare rates.
*Based on a blended coding mix for illustrative purposes.
5
Calculations Used to Estimate Direct Cost Savings
Inpatient palliative care has been examined in numerous studies to assess its impact on hospital costs. In 2018, Peter May, PhD, and other distinguished researchers published "Economics of Palliative Care for Hospitalized Adults with Serious Illness: A Meta-Analysis" in JAMA Internal Medicine.[3] In it, they reviewed six studies to assess the association between palliative care consultation and direct inpatient hospital costs. Previous versions of this Impact Calculator included financial estimates from one of the included studies, Morrison et al (2008).[4]
Key Findings:
- The analysis focused on palliative care consultations completed within three days of hospital admission.
- The analysis suggests a statistically significant reduction in direct costs ($3,237), regardless of diagnosis.
- For cancer patients, there was a $4,251 reduction in direct costs.
- For non-cancer patients, there was a $2,105 reduction in direct costs.
- Results are reported in inflation-adjusted 2015 dollars.
- There was a greater reduction in costs for patients with four or more comorbidities than for those with two or fewer.
Frequently Asked Questions
How should I use this information to help plan for program growth?
After you enter your data, look at Section 2 to see where your current statistics place your program. What quartile are you in for staffing? For penetration? Are they reasonably matched, or are they two quartiles apart? Consider using Section 1 and doing a three-year version, projecting staffing and volume for the next two years. What quartile are you in each year? How do your costs change? Your impact or savings? How can you use this to discuss and prioritize the use of your team, and focus on specific patient populations or performance metrics such as “time from admission to consult”? This provides perspective and comparative data. Use the calculations to help you plan specific local actions.
What if I don't have any data for annual inpatient admissions or discharges?
You can estimate annual admissions using the following shortcut:
[(Staffed Beds x 365 days) * Average Occupancy Rate] / Average Length of Stay = Estimate of Admissions
How is the 'Direct Cost Savings per Case' determined?
See Section 5, Estimates of Direct Cost Savings for Inpatient Palliative Care Consult Services, for additional detail. The $3,237 per case savings (May et al, 2018) is a statistically significant reduction in direct costs from an analysis of more than 133,000 cases of patients with and without palliative care. It is based on well-developed palliative care programs providing consultations completed within the first three days of hospital admission. This was an important characteristic to be able to compare the direct cost of the total inpatient stay to the cost of a patient without palliative care.
The Impact Calculator helps demonstrate the likely impact of cost savings related to patient volume and investment in services. These savings are spread across numerous cost budgets in the hospital. Look at the difference between cost savings per patient and staffing costs per patient in Section 1. Savings should significantly exceed costs and provide a basis for discussions about current and future budget investments to maintain quality care. The data in Section 2 should help you see how your program compares to others in patient volume and staff size, to also help plan forward.
Where can I find more resources to help me use the Impact Calculator for my program?
CAPC members have access to recurring Virtual Office Hours on demonstrating value through measurement, and tools and technical assistance on financing, demonstrating value, and making the case for palliative care.
Is there a way to customize the results using my own program data?
CAPC members can download our customizable Hospital Impact Calculator to input their own operations in Excel—staffing and salaries, total patients seen, initial and follow-up visit mix, and local billing rates—to estimate the total financial impact of their hospital’s palliative care team. Specifically, the customizable calculator estimates the hospital’s direct cost savings and billing revenue, net of expenses.
Palliative care champions can use this tool to advocate for resources and new initiatives, and can consider some of the embedded comparisons to national averages as they work to continuously improve operations.
Citations
- ↩ a Rogers M, Heitner R. Latest Trends and Insights from the National Palliative Care Registry™. Center to Advance Palliative Care webinar. August 13, 2019. https://www.capc.org/events/recorded-webinars/latest-trends-and-insights-from-the-national-palliative-care-registry/. Accessed May 26, 2021.
- ↩ a Rogers M, Dumanovsky T. How We Work: Trends and Insights in Hospital Palliative Care. Center to Advance Palliative Care. September 10, 2020. https://www.capc.org/documents/400/. Accessed May 26, 2021.
- ↩ a May P, Normand C, Cassel JB, et al. Economics of Palliative Care for Hospitalized Adults with Serious Illness: A Meta-analysis. JAMA Intern Med. 2018 Jun 1;178(6):820-829. doi:10.1001/jamainternmed.2018.0750.
- ↩ a Morrison RS, Penrod JD, Cassel JB, et al. Cost savings associated with US hospital palliative care consultation programs. Arch Intern Med. 2008;168(16):1783-1790. doi:10.1001/archinte.168.16.1783.