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The business of palliative medicine—Part 2: The economics of acute inpatient palliative medicine

Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic Taussig Cancer Center, Cleveland, Ohio

Declan Walsh, MSc, FACP, FRCP (Edin)

Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic Taussig Cancer Center, Cleveland, Ohio

Kristine A. Nelson, MD

Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic Taussig Cancer Center, Cleveland, Ohio

Dale Konrad, MBA

Division of Finance, Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic Taussig Cancer Center, Cleveland, Ohio

Susan B. LeGrand, MD

Palliative Medicine Fellowship Program, Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic Taussig Cancer Center, Cleveland, Ohio

Lisa Rybicki, MS

Department of Biostatistics, Harry R. Horvitz Center for Palliative Medicine, The Cleveland Clinic Taussig Cancer Center, Cleveland, Ohio

Economic feasibility is a major factor in the viability of established acute inpatient palliative medicine. Several clinical, administrative, and financial parameters determine the financial health of inpatient care. Financial management metrics include case mix index (CMI) (as determined by the Federal Register as an assigned relative weight to the diagnosis-related group (DRG) reflecting resource consumption), direct costs, indirect costs, contribution margin, and in the future of all patient revised-DRG (APR-DRG). Both census and length of stay will have a major impact on these financial metrics. The type of patient referral and clinical decisions will influence direct costs and revenues. In the future, an international CMI or APR-DRG will allow palliative inpatient units to compare disease severity, resource utilization, and outcome measures.

Key Words: all patient refined • case mix index • contribution margin • diagnosis-related group • length of stay • palliative medicine

American Journal of Hospice and Palliative Medicine®, Vol. 19, No. 2, 89-95 (2002)
DOI: 10.1177/104990910201900206


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