The earlier a patient receives palliative care, the larger the return on investment, an analysis by the Pennsylvania-based health system WellSpan Health has found.

Palliative care is often viewed as a cost center in health care, rather than a revenue generator. Beginning in 2018, WellSpan began to test that theory by examining financial metrics associated with its palliative care services, with a focus on cost savings.

Based on that analysis, the general perception that palliative care costs more money than it saves doesn’t hold water, Dr. Vipul Bhatia, associate chief medical officer for WellSpan said at the National Hospice and Palliative Care Organization Annual Leadership Conference.

However, the resulting ROI depends on a number of variables, such as the timeframe for initiating palliative care, the program’s scale and staffing levels.

“We evaluated the inpatient paths for palliative care-eligible patients, comparing those who received palliative care versus who did not. We found that there were lower costs associated with patients who received palliative care services in the hospitals,” Bhatia said at the conference. “We identified the contributing factors to that lower cost and, just to name a few, they were higher penetration rates and lower length of stay between admission to palliative care services.”

WellSpan Health is an integrated health system with more than 20,000 employees and 3,600 volunteers. The system includes 220 patient care locations, eight hospitals, a regional behavioral health organization and a regional home-based care agency.

The company offers palliative care on an inpatient and outpatient basis in addition to its home-based services, using an interdisciplinary model that includes physicians, advanced practice providers, nurses, coordinators, social workers and chaplains.

The cost-benefit analysis of WellSpan’s palliative care programs found that, at the system level, palliative care reduced costs per patient by 6%. However, at one of their hospitals the savings were considerably higher, according to Bhatia.

“There was a 20% lower cost in one of the hospitals. So we did a deep dive into that hospital performance and saw what could potentially have been the contributing factors for such a significant performance,” he said. “What we learned was that the hospital had a significantly higher palliative care penetration rate compared to all other hospitals or the system average — which was 5%. This hospital was at 10%.”

The outlier hospital also had the lowest amount of time between admission and initiation of palliative care at 1.7 days, compared to four days or more for its other facilities.

These data provided a “roadmap” for scaling palliative care system-wide, Bhatia said.

The health system developed plans to bring its other hospitals’ programs to a 10% penetration rate and to speed the introduction of those services to eligible patients. To date, the system has exceeded those targets, he indicated.

WellSpan also launched pilot initiatives in its emergency departments to fast track palliative care to patients in need.

“[The analysis] gave us a very, very good insight in terms of how we effectively utilize palliative care services that are present in our hospitals,” Bhatia said. “If we have to develop and grow palliative care services across the system, not only do we have to have teams present on the ground, but we have to aim for more and more patients to be seen by palliative care by increasing the penetration rate. We do not see the same benefit if that intervention is too late during the hospitalization. We have to see them early enough to see the impact.”