A Retrospective Analysis Examining the Mount Carmel Health System's Opportunity for Development of a Community-Based Palliative Care Delivery Model

According to the Center to Advance Palliative Care (CAPC), palliative care, and the medical sub-specialty of palliative medicine, is specialized medical care for patients living with serious, complex and chronic illnesses such as cancer, congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), kidney failure, Alzheimer's, Parkinson's, and Amyotrophic Lateral Sclerosis (CAPC, 2016). The design and implementation of successful community based palliative care programs primarily serve the health care needs of this patient population. Yet beyond the clinical aspects of these programs, they can also reduce non-beneficial utilization of acute care hospital services when the costs from such admissions typically exceed revenues. Community-Based Palliative Care (CBPC) programs are becoming increasingly important as the volumes and costs of caring for chronically ill Medicare patients has become a daunting challenge across the United States. As the United States faces these ominous health care trends, there are strong incentives for hospitals and health systems to consider community-based palliative care programs that serve these resource intensive populations. Improved patient outcomes such as better symptom control and clarity on goals of care translate into avoided adverse episodes of care and improved planning. Complementing these outcomes are the secondary effects, which include reduced health service utilization of unnecessary hospital admissions and emergency department visits.;Mount Carmel Health, a member of the Trinity Health System, is conscious of the positive clinical and quality-of-life outcomes that result from earlier engagement of palliative care patients. Contrary to traditional fee-for service payment models, the Mount Carmel palliative care program incorporates a ''less is more'' philosophy, concentrating attention on patient and family needs. Long resource-intensive admissions toward the end of life typically do not generate the kind of positive net margin that hospitals see for the bulk of their admissions. Recognizing that a single end-of-life hospitalization can possibly produce negative net margins, resulting in a readmission from a prior hospitalization or potentially the patient's death within 30 days emphasizes the importance of alternative end-of-life models. This Mount Carmel Health study adds to previous community-based palliative care studies both in methodology and practical application. Spanning the calendar years 2012 through 2015, a Mount Carmel retrospective palliative care opportunity analysis was conducted to assess the opportunity to develop a community-based palliative care program suited to the needs of Mount Carmel palliative care patients. Following a systematic methodology that examines hospitalizations near the end of life, this study will strive to identify the Mount Carmel costs incurred for a decedent population over a 32-month time span, as well as identify the associated insurance payer reimbursement. Quantifying palliative care savings opportunities provides a useful justification for hospital administrators to identify, at the health system level, the need for a community-based palliative care program and the expected impacts of such services. This study will attempt to identify the health care leverage points that strengthen the business case for development of a Mount Carmel community-based palliative care program by examining where fiscal and quality incentives are aligned.