October 2012 Edition Vol.11, Issue 10

The Business Case for Integrating Palliative Care into Oncology Practice

The Business Case for Integrating Palliative Care into Oncology Practice (continued)

Michael Rabow, MD, Director of the Symptom Management Service at the Helen Diller Family Comprehensive Cancer Center and Professor of Clinical Medicine at UCSF explains that, “Palliative care practices must be aligned with and supported by a larger institution to be sustainable financially. Cancer centers must commit to providing palliative care to all patients who need it, as ASCO now calls for.”

According to a study published in 2010, the benefits of providing outpatient palliative care services are quantifiable for both patients and oncologists.7 In the study, patients had their symptom burden reduced by an average of 21%, according to the Edmonton Symptom Assessment System survey.Each palliative care referral saved about 170 minutes of time for the referring oncologist. This led to the oncology practice saving just over 4 weeks of time (162 hours) during the second year of having the palliative care clinic embedded into an office-based oncology practice. 

This time savings meant that oncologists could focus on evaluating new patients, test results, and treatment options. Moreover, the respondents reported high levels of satisfaction with the palliative care, and the number of patients that they referred increased over time. 

Embedding the palliative care practice into the oncology practice meant that the shared physical space and close contact allowed the practices to integrate efficiently. According to Dr. Rabow, benefits for offering palliative care practices affiliated with cancer practices include: 

  1. Co-management frees up oncologists’ time from managing pain and depression and from such tasks as running family meetings. 
  2. The positive public perception of palliative care and the ASCO consensus on the subject mean that offering palliative care may be a competitive advantage among local competitors who do not offer this state-of-the art cancer care.
  3. Depending on the practice and its involvement in a shared risk network, the larger institution may benefit from an expected decrease in hospitalizations and chemotherapy at the end of life.

Lynn Hill Spragens, MBA, of Spragens & Associates and of the Center to Advance Palliative Care (CAPC), says “The model of palliative care embedded in the cancer center, with co-management capability, has the following operational advantage: by utilizing existing space and support functions, overhead is minimized, and costs are limited to direct costs for team members and billing functions.”

Notably, the availability of outpatient palliative care services is not yet widespread. A survey of cancer center executives in 2010 found that less than half offered outpatient palliative care services. While 54% of National Cancer Institute (NCI) cancer centers had palliative care clinics in place, only 20% of non-NCI cancer centers had dedicated outpatient palliative care clinics.8 The executives surveyed cited financial constraints as the major obstacle to effectively delivering palliative care.

Financial and Personnel Challenges

Sustaining a palliative care program can be a financial challenge, since the current business model for palliative care is unusual.9 The current model is based on avoiding costs by reducing unwanted and unnecessary utilization, rather than on generating revenue. Successfully employing this model requires forethought about measurement methods to integrate palliative care into the operating metrics of hospitals. 

“The financial case for palliative care is relevant to the bigger picture of health system costs or total costs of care,” explained Spragens. “For complex patients, adding the costs of palliative care can be more than offset by savings on admissions, emergency expenses, or redundant or ineffective tests and treatments. Programs will need to examine the alignment issues at the system level.”


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