CaseMaker PCS PCQN Conference October 8, 2014 Steven Z. Pantilat, MD Shayna McElveny
CaseMaker • At last!!!
CaseMaker A web-based, automated, simple to use • financial analysis tool for PCS Calculate cost savings, net margin and • bed days saved Produce an editable report with your • financial data Demonstrate ROI • Combine with outcomes to show value • Get more resources for your busy team! •
CaseMaker Approach • Early PC: by Day 1 – Compare cost of entire admission to Late PC • Later PC: Day 2+ – Compare pre-PCS costs to post-PCS • Fiscal benefits – Avoided/reduced costs – Improved net margin • Operational benefits – Avoided med-surg and ICU bed days 4
Early PC PCS by Day 1 Mr. B is an 81-year-old man with diabetes, coronary artery disease, peripheral vascular disease and dementia who had been living at home with his daughter and son-in-law. On the morning of admission the family found him less responsive and with a deeply purple lower right leg. The family brought Mr. B to the ED. A diagnosis of acute arterial obstruction and evolving gangrene was made. Both vascular surgery and palliative care were called to consult on the case. The vascular team examined the patient and recommended amputation of the limb. The PC team met with the family, since the patient was unable to participate in the goals of care discussion. The family explained that the patient's health issues had escalated to a point where his quality of life was very poor and that he had expressed in the past a strong desire not to have amputation. They opted not to pursue surgical intervention. The patient was admitted to the medical service and co- managed by the PCS. Treatment focused on comfort and pain management. His family felt uncomfortable caring for him at home at this point. He died in the hospital after a six day stay. 5
Early PC PCS by Day 1 Compare total variable direct costs of “Early PC” cases to those of “Later PCS” cases $2,500 $2,300 Initial Consult $2,100 “Later - PC” Avoided Costs $1,900 $1,700 $1,500 $1,300 Avoided Costs & $1,100 Initial Consult “Early - PC” Avoided Bed $900 Days $700 $500 1 2 3 4 5 6 7 8 9 10 Later-PC Early-PC 6
Later PC Day 2 and beyond The PCS consults on a 78 year-old woman with advanced metastatic colon cancer who was admitted to the ICU from the emergency department with recurrent gastrointestinal bleeding and hypotension. At the time of PCS consultation, the patient had been in the hospital for six days. Following a discussion with the patient and family about prognosis and patient wishes/values/preferences, the patient is transferred to an acute care bed, where treatment goals shift to managing her nausea, pain and fatigue. Blood draws, vital signs and transfusions are stopped. The patient continues to have gi bleeding that makes it difficult to send her home. The PC team follows the patient daily to ensure optimal symptom management and to support the patient and family. The patient dies in the hospital four days later. 7
Later PC Day 2 and beyond Patients serve as their own controls Costs in the days before PCS are compared to costs after $3,000 $2,500 Reduced $2,000 Costs Initial PC $1,500 Consult $1,000 $500 1 2 3 4 5 6 7 8 9 10 PC Usual Care 8
CaseMaker Data Elements • From your hospital – Visit Level (entire admission) Cost Data – Daily Cost Data • From you/PCQN – PCS level data (consult date)
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