title: Financial effect of clinical decisions: case study of a dialysis center.
abstract: The purpose of this study was to specify the financial effect of clinical decisions in a dialysis center. A consecutive sample of 14,343 outpatient hemodialysis treatments (OHD), 16,111 continuous ambulatory peritoneal dialysis (CAPD), and 4,513 chronic cycler-assisted peritoneal dialysis (CCPD) days of treatment was analyzed. An activity-based cost calculation method was applied to the analysis of alternative treatments (service bundles). The weekly cost of OHD was higher ($338 versus $241/$242), and the contribution margin (reimbursement minus total cost) of CAPD/CCPD was much greater ($.48 versus $148/$147 per patient week). Clinical decision-making had an influence on less than 6.8% of OHD and 45.4%/46.6% of CAPD/CCPD related expenses. In comparison to activity-based cost calculation, conventional methods overestimated the overhead expense of CAPD by 3-48%. This study documented that most cost control opportunities reside in the usual process of care and less can be influenced by a direct interference with the patient-physician contacts. Paying for 1 week of renal replacement (capitation) could simplify the process of reimbursement and cost tracking.
authors: School of Medicine and School of Business and Public Administration, University of Missouri, Columbia, Missouri 65211, USA.
authors: E A
authors: EA
authors: Balas
authors: L L
authors: LL
authors: Hicks
authors: J V
authors: JV
authors: Stone
authors: L P
authors: LP
authors: Ponferrada
authors: D A
authors: DA
authors: West
mesh_terms: D000554:Ambulatory Care Facilities / Q000191:economics* / Q000706:statistics & numerical data; D002201:Capital Expenditures; D016009:Chi-Square Distribution; D003363:Cost Control; D003657:Decision Making; D017050:Episode of Care; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008923:Missouri; D012051:Reimbursement Mechanisms; D006435:Renal Dialysis / Q000191:economics*