Financial effect of clinical decisions

Case study of a dialysis center

E Andrew Balas, Lanis L. Hicks, John Van Stone, Leonor P. Ponferrada, David A. West

Research output: Contribution to journalArticle

3 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)465-474
Number of pages10
JournalJournal of Medical Systems
Volume19
Issue number6
DOIs
StatePublished - Dec 1 1995

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Dialysis
Continuous Ambulatory Peritoneal Dialysis
Costs and Cost Analysis
Peritoneal Dialysis
Renal Dialysis
Outpatients
Costs
Therapeutics
Cost Control
Physicians
Kidney
Decision making

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Information Systems
  • Health Informatics
  • Health Information Management

Cite this

Financial effect of clinical decisions : Case study of a dialysis center. / Balas, E Andrew; Hicks, Lanis L.; Van Stone, John; Ponferrada, Leonor P.; West, David A.

In: Journal of Medical Systems, Vol. 19, No. 6, 01.12.1995, p. 465-474.

Research output: Contribution to journalArticle

Balas, EA, Hicks, LL, Van Stone, J, Ponferrada, LP & West, DA 1995, 'Financial effect of clinical decisions: Case study of a dialysis center', Journal of Medical Systems, vol. 19, no. 6, pp. 465-474. https://doi.org/10.1007/BF02260850
Balas, E Andrew ; Hicks, Lanis L. ; Van Stone, John ; Ponferrada, Leonor P. ; West, David A. / Financial effect of clinical decisions : Case study of a dialysis center. In: Journal of Medical Systems. 1995 ; Vol. 19, No. 6. pp. 465-474.
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