38 Background: Palliative care (PC) combined with standard oncology care has been shown to improve patient outcomes and reduce health care costs. In safety-net systems, where limited resources mandate containing costs across settings, outpatient PC (OP PC) could be an important tool for improving quality while lowering costs. Multiple studies have shown that oncology patients cared for in safety net systems often present very late in the course of illness, raising concerns about the proportion of patients who could be referred to an OP PC clinic. To address this question we analyzed utilization patterns among cancer patients cared for at our facility to examine the need for and expected net costs of an OP PC service. Methods: Retrospective cohort study of oncology patients cared for at an urban, safety-net hospital who died between July 2010 and June 2013. We used cancer registry data to identify decedents and claims data to evaluate utilization patterns and cost of care in the final 6 months of life. Results: Among the 403 cancer patients who died in the study period we found heavy, late utilization of inpatient (IP) services: 307 (76%) were admitted to the hospital in the 6 months preceding death, 45% in the final month of life. One third of patients died in the hospital and another 4% died within 3 days of hospital discharge. Direct costs per admission averaged $22,275. While late presentation was common, 133 (33%) patients had multiple health system encounters 91-180 days prior to death: early enough to be referred to an OP PC clinic. We modeled clinic costs assuming an annual volume of 50 patients, to be followed monthly for the last 4 months of life by a physician-nurse-social worker team. Annual staffing costs were estimated at $88,290. Prior research has shown that utilization of IP services in the final month of life is 40% lower amongst patients who receive early OP PC. Using that value, we estimated that providing OP PC to 50 patients annually would avoid 38 hospitalizations, with resulting avoided direct costs of $846,450. Conclusions: This feasibility study reveals that OP PC in the safety net can provide substantial return on investment, even if such services are only used by a subset of oncology patients who present earlier in their disease course.