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Lower cost of care for serious chronic disease by increasing services not restrictions

Edes T, Shreve S, Klepac L, Kinosian B. Lower cost of care for serious chronic disease by increasing services not restrictions. Poster session presented at: American Geriatrics Society Annual Meeting; 2012 May 3; Seattle, WA.


Purpose: To demonstrate that systems can increase access, improve quality and lower total cost of care by adding services rather than restricting services. Background: Congressional Budget Office report (2007) noted the cost per patient per year in the 7 years from 1998 to 2005 rose 29% in Medicare, while costs rose only 1.7% in Department of Veterans Affairs (VA). The highest cost patients were those with multiple serious chronic diseases, many of whom were homebound. One factor attributed for VA's cost containment was that VA has programs in place specifically for persons with serious chronic disease. VA has continued to expand programs specifically for Veterans with serious advanced chronic disease to receive patient centered care in the least restrictive setting. We report an economic impact analysis of two such VA programs: Hospice and Palliative Care (HPC), and Home Based Primary Care (HBPC). Methods: VA databases were used to determine Veterans' use of HBPC, use of HPC in all settings, and location of death. Utilization and costs of care were determined for 2003 and 2010. Results: Between 2003 and 2010, while the number of VA enrollee deaths decreased11%and the number ofVAinpatient deaths decreased 15%,the number of deaths in VA acutemedical hospital decreased 36%, the number inVA inpatient hospice beds increased 179% and the number of Veterans in VA-paid home hospice increased 592%. 4582 fewer deaths occurred in acute medical plus ICU, and 5731 more Veterans received VA-paid home hospice per day.With the cost difference, the net cost reduction was over $8 million for each day 4500 Veterans received care in home hospice rather than VA acute medical inpatient care.The number of Veterans receiving HBPC increased 190%. Total net cost avoidance for 24,957 HBPC patients was over $70 million, at $2900 per patient per year largely by reducing avoidable inpatient days. Conclusion: Increasing access to inpatient hospice care, toVA-paid home hospice care and to VA-provided HBPC resulted in net reductions in total VA costs of care, without imposing any restrictions of services.

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