title: Impact of a New Palliative Care Program on Health System Finances: An Analysis of the Palliative Care Program Inpatient Unit and Consultations at Johns Hopkins Medical Institutions.
abstract: Palliative care inpatient units (PCUs) can improve symptoms, family perception of care, and lower per-diem costs compared with usual care. In March 2013, Johns Hopkins Medical Institutions (JHMI) added a PCU to the palliative care (PC) program. We studied the financial impact of the PC program on JHMI from March 2013 to March 2014.
  
  
  
  This study considered three components of the PC program: PCU, PC consultations, and professional fees. Using 13 months of admissions data, the team calculated the per-day variable cost pre-PCU (ie, in another hospital unit) and after transfer to the PCU. These fees were multiplied by the number of patients transferred to the PCU and by the average length of stay in the PCU. Consultation savings were estimated using established methods. Professional fees assumed a collection rate of 50%.
  
  
  
  The total positive financial impact of the PC program was $3,488,863.17. There were 153 transfers to the PCU, 60% with cancer, and an average length of stay of 5.11 days. The daily loss pretransfer to the PCU of $1,797.67 was reduced to $1,345.34 in the PCU (-25%). The PCU saved JHMI $353,645.17 in variable costs, or $452.33 per transfer. Cost savings for PC consultations in the hospital, 60% with cancer, were estimated at $2,765,218. $370,000 was collected in professional fees savings.
  
  
  
  The PCU and PC program had a favorable impact on JHMI while providing expert patient-centered care. As JHMI moves to an accountable care organization model, value-based patient-centered care and increased intensive care unit availability are desirable.
authors.affiliation: Johns Hopkins Bloomberg School of Public Health; Johns Hopkins Health System; Johns Hopkins Medical Institutions, Baltimore, MD; Sunnybrook Odette Cancer Centre; University of Toronto; and Canadian Centre for Applied Research in Cancer Control, Toronto, Ontario, Canada.
authors.forename: Sarina R
authors.initials: SR
authors.lastname: Isenberg
authors.affiliation: Johns Hopkins Bloomberg School of Public Health; Johns Hopkins Health System; Johns Hopkins Medical Institutions, Baltimore, MD; Sunnybrook Odette Cancer Centre; University of Toronto; and Canadian Centre for Applied Research in Cancer Control, Toronto, Ontario, Canada.
authors.forename: Chunhua
authors.initials: C
authors.lastname: Lu
authors.affiliation: Johns Hopkins Bloomberg School of Public Health; Johns Hopkins Health System; Johns Hopkins Medical Institutions, Baltimore, MD; Sunnybrook Odette Cancer Centre; University of Toronto; and Canadian Centre for Applied Research in Cancer Control, Toronto, Ontario, Canada.
authors.forename: John
authors.initials: J
authors.lastname: McQuade
authors.affiliation: Johns Hopkins Bloomberg School of Public Health; Johns Hopkins Health System; Johns Hopkins Medical Institutions, Baltimore, MD; Sunnybrook Odette Cancer Centre; University of Toronto; and Canadian Centre for Applied Research in Cancer Control, Toronto, Ontario, Canada.
authors.forename: Kelvin K W
authors.initials: KKW
authors.lastname: Chan
authors.affiliation: Johns Hopkins Bloomberg School of Public Health; Johns Hopkins Health System; Johns Hopkins Medical Institutions, Baltimore, MD; Sunnybrook Odette Cancer Centre; University of Toronto; and Canadian Centre for Applied Research in Cancer Control, Toronto, Ontario, Canada.
authors.forename: Natasha
authors.initials: N
authors.lastname: Gill
authors.affiliation: Johns Hopkins Bloomberg School of Public Health; Johns Hopkins Health System; Johns Hopkins Medical Institutions, Baltimore, MD; Sunnybrook Odette Cancer Centre; University of Toronto; and Canadian Centre for Applied Research in Cancer Control, Toronto, Ontario, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Cardamone
authors.affiliation: Johns Hopkins Bloomberg School of Public Health; Johns Hopkins Health System; Johns Hopkins Medical Institutions, Baltimore, MD; Sunnybrook Odette Cancer Centre; University of Toronto; and Canadian Centre for Applied Research in Cancer Control, Toronto, Ontario, Canada.
authors.forename: Deirdre
authors.initials: D
authors.lastname: Torto
authors.affiliation: Johns Hopkins Bloomberg School of Public Health; Johns Hopkins Health System; Johns Hopkins Medical Institutions, Baltimore, MD; Sunnybrook Odette Cancer Centre; University of Toronto; and Canadian Centre for Applied Research in Cancer Control, Toronto, Ontario, Canada.
authors.forename: Terry
authors.initials: T
authors.lastname: Langbaum
authors.affiliation: Johns Hopkins Bloomberg School of Public Health; Johns Hopkins Health System; Johns Hopkins Medical Institutions, Baltimore, MD; Sunnybrook Odette Cancer Centre; University of Toronto; and Canadian Centre for Applied Research in Cancer Control, Toronto, Ontario, Canada.
authors.forename: Rab
authors.initials: R
authors.lastname: Razzak
authors.affiliation: Johns Hopkins Bloomberg School of Public Health; Johns Hopkins Health System; Johns Hopkins Medical Institutions, Baltimore, MD; Sunnybrook Odette Cancer Centre; University of Toronto; and Canadian Centre for Applied Research in Cancer Control, Toronto, Ontario, Canada.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Smith
mesh_terms: D000046:Academic Medical Centers; D017046:Cost Savings; D003365:Costs and Cost Analysis; D003695:Delivery of Health Care / Q000191:economics*; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007297:Inpatients; D010166:Palliative Care / Q000191:economics*; D015397:Program Evaluation; D012017:Referral and Consultation