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Background: Palliative care (PC) programs attempt to improve communication and symptom management, and a consequence has been lower cost of in-hospital death. To date, most research has focused on urban large hospitals. This study reports the clinical and financial impact of a new palliative care service at a 76-bed nonprofit hospital located in rural Virginia, Rappahannock General Hospital (RGH). Methods: The RGH PC program started in 2006 with a part-time physician on grant support. We collected the number of consults, physician billing and receipts, and calculated the impact on the hospital's charges for patients treated with concurrent palliative care. Results: The program was well accepted clinically with referrals from most of the palliative care physician's colleagues. After the first year of operation, she has about 10 new consults and a total of 45 visits per month. Billings for this year are projected to be $59,070 and her collections are projected to be $29,604 (50%). Hospital charges per patient are reduced about $400 per day, or 25%, after a palliative care consultation, which sums to $80,000 to $130,000 yearly. Referrals to home hospice increased. Conclusions: Palliative care by a dedicated practitioner can work in rural areas. The income will be small, but the operational and financial benefits to the hospital can be significant. This is better care at a cost that rural hospitals and practitioners can afford. [ABSTRACT FROM AUTHOR]

Patients with multiple serious conditions account for a high proportion of health care spending. Such spending is projected to continue to grow substantially as a result of increased insurance eligibility, the ever-rising cost of care, the continued use of nonbeneficial high-intensity treatments at the end of life, and demographic changes. We evaluated the impact of palliative care consultation on hospital costs for adults with advanced cancer, excluding those with dementia. We found that compared to usual care, the receipt of a palliative care consultation within two days of admission was associated with 22 percent lower costs for patients with a comorbidity score of 2-3 and with 32 percent lower costs for those with a score of 4 or higher. Earlier consultation was also found to be systematically associated with a larger cost-saving effect for all subsamples defined by multimorbidity. Given ongoing workforce shortages, targeting early specialist palliative care to hospitalized patients with advanced cancer and higher numbers of serious concurrent conditions could improve care while complementing strategies to curb the growth of health spending. [ABSTRACT FROM AUTHOR]