Abstract
Implementation of palliative care (PC) in neurology settings may improve symptom control, quality of life, and reduce acute care admissions. The benefitis of team-based PC for patients with Parkinson’s disease (PD) has been established through rigorous evidence standards including randomized controlled trials. However, evidence on implementation costs and return on investment (ROI) are unknown and may guide other providers and systems considering this model of care.
We applied time-driven activity-based costing (TDABC) with reimbursable visits calculated using Medicare reimbursement rates in Colorado and current procedural technology codes to two outpatient clinics at the University of Colorado Hospital (UCH): neurology PC and movement disorders. Per patient ROI was calculated as the ratio of the incremental difference in financial revenues divided by the incremental difference in investment to expand PC services.
The cost per new patient was $154 and $98 for neuropalliative and movement disorders clinics, respectively. While established patient visits was $82 and $41 for the neuropalliative care and movement disorders clinics, respectively. The neurology PC clinic had per patient revenue for new and established visits of $297 and $147, respectively, as compared to $203 and $141 for new and established visits at the comparator clinic. Based on our assumptions, for every $1 invested in expanding PC services, a projected $1.68 will be recouped by the hospital system for new patient visits and $0.13 will be recouped for established patient visits. These amounts are context dependent and a calculator was created to allow other systems to estimate costs and ROI.
Our results suggest in an academic medical setting both neurology PC and movement disorders clinics provided increased revenue to the health system. Opportunities to improve ROI include efficient allocation of personnel to new and established visits, expanding telemedicine, and other cost offsets for complex patients not estimated in this analysis. ROI may also be greater in health systems that benefit from cost savings such as accountable care organizations. Our approach may be applied to other novel care models. Future research efforts will focus on estimating the continued sustainability of this innovative outpatient care model.
- Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.
This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0 (CC BY-NC-ND), which permits downloading and sharing the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
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