Hospice cost savings

In the March 2005 edition of Caring (a publication of the National Association for Home Care & Hospice) I found this quote on page 25:

The cost savings achieved by providing care to individuals at home compared to care provided within a hospital are huge. The average cost per day for hospitalized patients last year exceeded $1,000. The cost for a visit to the hospital emergency room was more than $5,000. By contrast, the average cost for home care services is about $100 per day. Even a cursory glance at these numbers emphasizes the importance of minimizing hospital admissions, especially readmissions via the emergency room.

The article deals with Home Health more than Hospice, but the numbers still ring very true. My agency is paid $105.49 per patient per day by Medicare no matter what we do for the patient that day. This means that, using very rough math, we are paid $6,000 for a patient who is on our service for two months. The same patient would rack up that much for one trip to the emergency room that resulted in a one day stay at the hospital. (We all know that there is no such thing as a one day hospital admission, but that's another subject.)

Here's the question that must be asked. Ignoring quality of life improvements that may come with hospice care in the home, does hospice care reduce hospitalization at the above stated rate. The answer is no; hospice reduces hospitalization much more than that!

I remember well one admission that I had trouble doing because the patient kept going back and forth to the hospital. He was a cancer patient who wasn't sure that he was ready for hospice. I was going to meet with he and his mother in their home to discuss what we could do to help, but the first two meetings were canceled because he had returned to the ER for pain management which, of course, ended up in a hospital admission. After the second one, I convinced them to allow me to come to the hospital and meet with them before discharge. He ended up signing up for our service before leaving the hospital and we were able to keep his pain under control at home for almost two months before he died. Before his hospice admission he had spent 39 of the last 60 days in the hospital. How much money do you think hospice saves the system on patients like this?

Let's do some quick math problems. Both examples below are an overview of the final 60 days of a patient's life and are very conservative in my opinion. I have also assumed (guessed) that pronouncing death at an emergency room takes only 1/2 of the usual $5,000 spent on an ER patient and have not included the cost of the EMS services for each trip to the ER.

Example 1:
Most end stage COPD patients/families freak out on a somewhat regular basis when the patient is having trouble breathing (it's hard to watch someone you love suffocate); without hospice that freak out ends up with a call to 911, a trip to the emergency room, and possibly but not always an admission to the hospital.

Without Hospice: If the patient/family freaks out once a month that's two trips to the ER ($10,000), one three day admission ($3,000), and death pronounced at the ER ($2,500). Total for non-hospice care: $15,500.

With Hospice: The patient/family calls hospice emergency number during freak out, on-call nurse makes visit, and ER visits are totally avoided. Nurse gets medications changed avoiding the inpatient hospital stay. Death happens at home, death is pronounced at home (how this happens from state to state varies significantly), funeral home comes to pick up the body. All of this is part of Routine Home Care hospice rate. Total for hospice care: $6,000.

Example 2:
A nursing home patient with end stage dementia gets a UTI causing a spike in fever and discomfort. (Some patients do this every couple of weeks and others once a year, so sticking with my conservative examples we'll assume it happens every other month.

Without Hospice: Nursing home calls EMS, trip to emergency room ($5,000), admitted for 5 days of antibiotics ($5,000). Patient death is pronounced at ER ($2,500) Total for non-hospice care: $12,500.

With Hospice: Nursing home calls on-call nurse, nurse gets antibiotic order from doctor, and case is closed. Total for hospice care: $6,000.

I can go on all day. There are many studies that show that hospice saves the system money. There are also many reports that people who have used hospice think it is the best things since instant oatmeal. Do the math on that, and it seems clear that the Medicare Hospice Benefit was one of the best ideas our federal government has come up with in a long time.

It is obvious that I am a hospice advocate, so if you need to crunch your own numbers, I say crunch away. As I said, there is ample proof that hospice saves the system money, and, when you finish burning the buttons off your calculator, stop and remember that the money you just saved the system also did a lot for the patients and their families. It's a win from any angle.

That's why I just can't understand why there are still so many doctors who think hospice is a dirty word that should remain on the list with chiropractors, acupuncture, and snake oil salesmen. It's time to accept the truth and start helping those that need help get exactly what they need.