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Executive Summary
Medicare's fixed daily rates create an absolute cost constraint on hospices; consequently, the growth in hospice brings financial pressures.
The patient efficacy of music therapy has been demonstrated in the literature and includes improving pain, agitation, disruptive behaviors, communication, depression, and quality of life.
Music therapy is well suited to hospice as it addresses the four domains of palliative care (physiological, emotional, social, and spiritual care).
In this small study, the total cost of patients in music therapy was $10,659 and $13,643 for standard care patients, resulting in a cost savings of $2,984. The music therapy program cost $3,615, yielding a cost benefit ratio of 0.83. When using cost per patient day, the cost benefit ratio is 0.95.
COMPLIMENTARY AND ALTERNATIVE THERAPIES ARE increasingly in use in health care today. Music therapy (MT), one modality examined in current literature, is gaining wider acceptance (Gallagher, Huston, Nelson, Walsh, & Steele, 2001). The patient efficacy of MT has been demonstrated in the literature and includes improving pain, agitation, disruptive behaviors, communication, depression, and quality of life. Some researchers have noted that MT also decreases the use of analgesics (Ikonomidou, Rehnstrom, & Naesh, 2004; Lukas, 2004; Pellino et al., 2005) and increases the efficiency and effectiveness of staff interventions (Ashida, 2000; Gerdner, 2005; Madan, 2005; Sung & Chang, 2005). While not explicitly looking at costs, these studies strongly suggest that MT may have a direct cost benefit by reducing medication costs and improving staff utilization.
Background
Hospice continues to be a rapidly growing and evolving area of health care in the United States. The Medicare Payment Advisory Commission (MedPAC, 2006) notes that the number of hospice beneficiaries increased by 49% from 2000 to 2004. Looking at the 2004 National Data Set reveals that 72% of hospice patients are Medicare recipients and that Medicare pays for 86% of all patient days (National Hospice and Palliative Care Organization [NHPCO], 2005). The survey also shows that cancer diagnoses now account for less than 50% of all hospice diagnoses. Though the average length of stay (ALOS) has increased from year to year, the median length of stay has remained around 21 days (NHPCO, 2005). These findings are also noted by MedPAC.
Medicare's fixed daily rates create an absolute cost...