PACE COPD ER & Hospital Cost Calculator
Estimate what COPD ER trips and hospital stays cost your PACE program each year. Compare a lower-use scenario and see the potential savings per enrolled member per month. Use your own claims: this is a planning estimate, not a promise of savings.
Inputs
Use average enrollment for the same year as your claims.
20% is an example, not a national PACE rate.
Use what your program pays, not billed charges.
Exclude ER costs already counted above.
Note: All example numbers are editable planning assumptions, not national PACE benchmarks. The 60% reductions are pilot targets, not proven Tele-RT outcomes. This estimates gross avoided costs, not net savings. ER and inpatient claims must not overlap. Never delay needed ER or hospital care to meet a cost target.
Formula
COPD participants = enrollment × COPD share, rounded to a whole person. ER cost = COPD participants × ER trips each × cost per trip. Hospital cost = COPD participants × stays each × cost per stay. Potential savings = ER cost × fewer ER trips % + hospital cost × fewer stays %. PMPM = annual savings ÷ total enrollment ÷ 12.
Worked example
With 233 enrolled and 20% with COPD, this model rounds to 47 COPD participants. At 2 ER trips each for $2,800 and 1 hospital stay each for $10,000, annual cost is $733,200. A 60% reduction in each would mean $439,920 less spending, or $157.34 per enrolled member per month, before program fees. The 60% figure is a pilot target, not a measured result.
Frequently asked
How do I find my PACE program's COPD costs?
Use a full year of paid claims and average enrollment. Count COPD-related ER trips and hospital stays. Include ambulance costs once, and keep ER and hospital amounts separate so the same claim is not counted twice.
Are these average costs for all PACE programs?
No. The example uses 20% with COPD, 2 ER trips and 1 hospital stay each year, $2,800 per ER trip and $10,000 per stay. These are planning assumptions. Local rates and patient needs vary.
Does Tele-RT guarantee 60% fewer visits?
No. The 60% settings are chosen pilot targets, not published PACE outcomes. Test a range of targets, including zero, and track actual use during a pilot.
What does savings per member per month mean?
It spreads potential yearly savings across all enrolled PACE participants and 12 months. PACE receives fixed monthly payments to cover care. This figure shows possible cost relief, not added payments or net profit.
Does this include the price of a monitoring program?
No. Subtract staff, equipment and service costs from the estimated savings to plan net savings. This tool does not measure quality of care or predict which participant needs a hospital.
References
- 1.CMS: PACE covers medical and supportive services through a coordinated care team. This source explains the program; it does not establish the example COPD rates or costs. https://www.medicare.gov/health-drug-plans/health-plans/your-coverage-options/other-health-plans/PACE
- 2.42 CFR §460.180 and §460.182: Medicare and Medicaid monthly payments to PACE organizations. Supports the fixed-payment context, not the reduction targets. https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-E/part-460/subpart-J
- 3.AHRQ HCUPnet: hospital-use and cost data. General hospital data are not PACE-specific paid claims and do not validate these example amounts. https://datatools.ahrq.gov/hcupnet
This calculator is for general planning and educational purposes only and is not clinical, legal, billing, or financial advice. Confirm all reimbursement, regulatory, and financial figures with a qualified professional and your organization's current policies before acting on anything here.
Breathing support through your PACE team
Beam's Tele-RT pilot supports COPD checks through PACE, with care-center checks and home support when your team chooses it.
See the PACE COPD pilot