Promoting Excellence : Executive Summary : Promising Preliminary Research Findings

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1. The Hospice of Michigan and the University of Michigan Comprehensive Cancer Center started a program that provides hospice care to patients who are receiving life-saving cancer treatments. When compared with patients receiving only cancer treatments, patients receiving both had fewer emergency room visits (0.8 vs. 1.07), fewer hospital admissions (1.65 vs. 1.83), and shorter hospital stays (7.7 vs. 9.9 days).

Average hospitalization costs for patients receiving only cancer care were $13,126 per patient, compared with $8,974 for those receiving both cancer care and hospice care. Average total costs for patients receiving only cancer treatments were $19,790 per patient, compared with $12,682 for those receiving both forms of care.

2. The Kaiser Hospice and Home Health program in Downey, California, provides home hospice care along with curative and restorative care to patients with congestive heart failure, respiratory disease and cancer, who probably have up to a year to live. A team of physicians, social workers, nurses and aides makes home visits to patients to develop treatment goals and provide care. The team also offers the family emotional and social support, as well as respite care. The program's goal is to prevent any unnecessary hospitalizations and ultimately allow patients to die at home, if possible.

Based on a two-year comparative study involving 300 patients who died, patients who were in the program reported higher satisfaction with the care they received. More than 87 percent of the program patients died at home, compared with less than 57 percent of the control group patients. The average daily cost for a patient in the palliative care program was $62 compared with $133 for a patient receiving usual care. Total per-patient costs for those in the program were 45 percent lower than for those receiving usual care ($7,990 vs. $14,570).

3. The Lillian and Benjamin Hertzberg Palliative Care Institute at Mt. Sinai Medical Center in New York provides a team of nurses and physicians who consult with hospital providers on how to manage pain and other symptoms, and how to talk to patients and family members about making sound decisions regarding life-sustaining care. The program was able to improve symptoms for all patients who were experiencing severe, moderate or mild levels of pain, nausea and breathing problems. Estimates of cost impact were based on the 519 Medicare patients who died at Mt. Sinai in 2001 with and without the help of the palliative care program. The patients receiving palliative care spent 360 fewer days in Mt. Sinai than did Medicare patients who were not on the program. The cost savings from palliative care were $757,555 for those patients who stayed longer than 14 days in the hospital and $455,936 for those who stayed more than 28 days.

A Call for Large-Scale Demonstrations
Academic researchers, program providers and advocates for the elderly all urged the government to test, on a wide-scale basis, models that offer combinations of life-prolonging and palliative care that have been shown, on a small scale, to improve quality of care and save money. Medicare could employ a number of different models in various regions of the country, offering all Medicare enrollees in each region access to that particular model. Such demonstration programs would provide the broad data needed to redesign the ways in which Medicare pays for end-of-life care.

"The time to act is now," Byock said. "We have the potential for providing not only ethically sound and medically competent care, but also care that offers so much more in terms of comfort and quality of life."

A transcript and other conference materials from "Financial Implications of Promoting Excellence in End-of-Life Care" are available online at For more information about Promoting Excellence programs visit

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Promoting Excellence in End of-Life Care is a National Program Office of The Robert Wood Johnson Foundation dedicated to long-term changes in health care institutions to substantially improve care for dying persons and their families. Visit for more resources.

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