Pediatric Concurrent Hospice Care: Cost Implications of a Hybrid Payment Model.
Melanie J Cozad, Radion Svynarenko, Pamela S Hinds and 3 others
PMID 35437021WHAT IT FOUND
Children in pediatric hospice who also received non-hospice medical care had higher outpatient and medication costs across all stays than standard hospice care.
Total and inpatient costs were lower for 2 to 14 day stays, but higher for stays of 15 days or more.
Key findings
01Across all hospice lengths of stay, concurrent hospice care was associated with higher outpatient costs by $6.61 per month and higher prescription drug costs by $5.18 per month compared with standard hospice care.
02For hospice stays of 2 to 14 days, concurrent care was associated with lower total costs by $202.11 per month and lower inpatient costs by $63.29 per month, but higher prescription drug costs by $2.70 per month.
03For hospice stays of 15 days or more, concurrent care was associated with higher total costs by $1903.94 per month, higher inpatient costs by $740.22 per month, higher outpatient costs by $28.94 per month, and higher prescription drug costs by $281.01 per month.
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What it does not show
The reported costs are Medicaid reimbursement amounts, not the full cost of services. The data were only from 2011 to 2013, the early years of national Medicaid concurrent hospice care. Results apply only to Medicaid beneficiaries younger than 21 who died, not to other insurance or older patients. Concurrent hospice care implementation was not immediate or uniform across states, which could bias the comparison. The study was non-experimental, so it cannot prove that concurrent care caused the cost differences. The data agreement prevented reporting some small subgroup numbers under 10%. It did not include quality of care, health related quality of life, or patient and parent reported outcomes.
The easy way to misread this
Do not conclude that concurrent hospice care saves money. The study is observational; outpatient and medication costs were higher across all stays, and total and inpatient costs were higher for stays of 15 days or more.