Who pays for biliary complications following liver transplant? A business case for quality improvement.
We use biliary complication following liver transplantation to quantify the financial implications of surgical complications and make a case for surgical improvement initiatives as a sound financial investment. We reviewed the medical and financial records of all liver transplant patients at the UMHS between July 1, 2002 and June 30, 2005 (N = 256). The association of donor, transplant, recipient and financial data points was assessed using both univariable (Student's t-test, a chi-square and logistic regression) and multivariable (logistic regression) methods. UMHS made a profit of $6822 +/- 39087 on patients without a biliary complication while taking a loss of $5742 +/- 58242 on patients with a biliary complication (p = 0.04). Reimbursement by the payer was $5562 higher in patients with a biliary complication compared to patients without a biliary complication (p = 0.001). Using multivariable logistic regression analysis, the two independent risk factors for a negative margin included private insurance (compared to public) (OR 1.88, CI 1.10-3.24, p = 0.022) and biliary leak (OR = 2.09, CI 1.06-4.13, p = 0.034). These findings underscore the important impact of surgical complications on transplant finances. Medical centers have a financial interest in transplant surgical quality improvement, but payers have the most to gain with improved surgical outcomes.
Englesbe
M J
MJ
Department of Surgery, Division of Transplantation, University of Michigan Health System, Ann Arbor, Michigan, USA. englesbe@med.umich.edu
Dimick
J
J
Mathur
A
A
Ads
Y
Y
Welling
T H
TH
Pelletier
S J
SJ
Heidt
D G
DG
Magee
J C
JC
Sung
R S
RS
Punch
J D
JD
Hanto
D W
DW
Campbell
D A
DA
D000328:Adult; D005260:Female; D005705:Gallbladder Diseases / Q000191:economics* / Q000209:etiology*; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects* / Q000592:standards; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000191:economics*; D012051:Reimbursement Mechanisms