Implementation Costs of Technology-Enhanced Transitional Palliative Care for Rural Caregivers.
Brystana G Kaufman, Diane E Holland, Catherine E Vanderboom and 10 others
PMID 36798053WHAT IT FOUND
RN-led video, phone, and text transitional palliative care for rural caregivers cost about $395 per caregiver.
Billing both transitional care management and chronic care management could cover it, but either alone did not.
Key findings
01In the trial, caregivers in the intervention group received an average of 9.2 visits, each about 45 minutes, and nurses spent 8.9 hours per caregiver across activities.
02Base case cost was $395 per caregiver with a registered nurse, $337 with a social worker, and $585 with a nurse practitioner.
03Reimbursement was higher than the $395 base cost when transitional care management and chronic care management were combined, and lower when either was used alone.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The paper estimates costs and reimbursement; it does not test whether the intervention improves caregiver or patient outcomes. Costs were built from trial resource use and national wage rates, so local wage rates and workforce availability may change the result. Overhead and capital costs were excluded, and research time was also excluded. Reimbursement scenarios assumed Medicare rules and an 85% payment rate for non-physician staff, so actual billing may differ. Visits before discharge and visits during bereavement were not reimbursable in the scenarios presented. The trial used experienced palliative care nurses, so other staff mix may change cost and feasibility. There was wide variation in visits and hours, and number of visits had the greatest influence on cost. Cost sharing could add burden for caregivers if each visit required a fee.
Declared interests
The supplied text gives a ClinicalTrials.gov registration number but does not report funding sources or author conflicts of interest.
The easy way to misread this
Do not read the $395 cost and reimbursement figures as proof that the program helps caregivers. The paper analyzes costs and potential billing, not patient or caregiver outcomes.