1. Hospital-ity ~ Palliative Care: Impact on Quality of Care & Cost

2. Hospitality A Relationship The Act & Practice of Being Hospitable Hospitality derives from the Latin hospes The meaning of "host" can be literally read as "lord of strangers

3. Host Hospital "shelter" "guest-house" "friendliness to guests" He who Receives Guests," Clinical 1780: "pertaining to hospital patients or hospital care," from clinic + -al (2). Meaning "coldly dispassionate" (like a medical report) is recorded from 1928.

4. Improved Quality

5. Determine Quality by the Manner of the People

6. Case Management Principles The Patient is the Focal Point. Provide Information and Personal Assistance Support Informed Choices More satisfying and less costly. Support the patient/physician Relationship Respect and protect the Patients Right to Choose Enable Maximum Effect of Insurance Benefits

7. Reduced Costs

8. Palliative Care Reduces Length of Stay Clarifies goals of care with patients and families. Helps families to select medical treatments that meet goals. Assists families in decisions to withhold or withdraw death prolonging treatments that do not meet goals. Mount Sinai Hospital Data -2001 Medicare Data: Palliative Care Patients spent 360 fewer days in Mt. Sinai as compared to DRG-Matched patients not followed by Palliative care Medicare patients who passed with LOS >14 days

9. Reductions in Total Costs for Medicare Beneficiaries in 2001 Cost savings from palliative care = $757,555 per year for patients with LOS>14days Cost savings for Palliative Care = $455,936 per year for patients with LOS >28 days Cost per day=total per DRG/Avg LOS per DRG for patients who passed Costs reduced by palliative care= Cost per day x number of days saved by Palliative Care

10. Implications of LOS Reduction Patients with advanced illness have a long length of stay & high cost/admission. Palliative Care results in: Reduction in Length of Stay Reduction in Total Costs/Admission Opportunity for New Admissions Better Quality of Care Highly Satisfied Families

11. Evaluate yourself by Your Own Standards, not someone else’s.