PM2014: A Financial and Operational Model for a Pediatric Palliative Care Unit

Background: Pediatric illnesses and deaths are often complex and require additional support for patients and their caretakers. Children with terminal diagnoses are hospitalized frequently, which can become costly for patients and hospitals due to the increased utilization of resources. Additional hospitalizations consume precious time and can fail to provide comfort in the end stages of their life. Pediatric Palliative Care (PCC) is designed to address the concerns of unnecessary hospital costs while optimizing care by integrating a palliative care team within existing hospital infrastructure.

Methods: Literature reviews analyzing capacity over several visits per month in an adult palliative care setting were conducted to assess the following variables of a palliative care facility length of stay in hospital and/or ED with and without palliative care intervention, average cost per hospital admission, costs for patients discharged alive, costs for patients who died in the hospital, and the difference in direct cost for patients before and after palliative consultation. Then, hospital admission data was retrieved from Norton Hospital, a comparable hospital, in Louisville, KY, and the annual cost savings, budget, and annual growth of the palliative care program from 2016-2021 was analyzed. This data was used as a reference to estimate pediatric palliative census and finances.

Results: Our model suggests using representative estimates including 10,000 annual in-patient admissions, a 10% penetration rate for pediatric palliative care consults, average Kentucky Medicaid billing revenue per episode of care, an average cost savings of $3,331 per patient, and the cost per total interdisciplinary team (IDT) full-time equivalents (FTEs). Our financial analysis yielded the breakeven point of our Pediatric Palliative care service line to be 16 patients per month. Our Epic Inpatient analysis yields an expected 83 patients per month which was well over the breakeven point and expects to generate a monthly net revenue of $245,325. Overall, our financial analysis shows financial viability, and even an advantage, of creating a PCC.

Conclusion: The integration of a pediatric palliative care unit is viable and advantageous on a fiscal front. This unit generates cost savings for hospitals by allocating resources to reduce hospital admissions, non-palliative treatment and tests, and ED visits. This, in turn, saves patient costs on financial, time, and health fronts. By incorporating this service, patients and their families can have humane and caring service that was previously not offered. Therefore, our model suggests that a pediatric palliative care unit is financially and clinically advantageous.