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The cost of caring for end-stage kidney disease patients: an analysis based on hospital financial transaction records.

F J Bruns, P Seddon, M Saul and M L Zeidel
JASN May 1998, 9 (5) 884-890;
F J Bruns
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P Seddon
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M Saul
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M L Zeidel
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Abstract

The costs of care for end-stage renal disease patients continue to rise because of increased numbers of patients. Efforts to contain these costs have focused on the development of capitated payment schemes, in which all costs for the care of these patients are covered in a single payment. To determine the effect of a capitated reimbursement scheme on care of dialysis patients (both hemodialysis [HD] and peritoneal dialysis [PD]), complete financial records (all reimbursements for inpatient and outpatient care, as well as physician collections) of dialysis patients at a single medical center over 1 year were analyzed. For the period from July 1994 to July 1995, annualized cost per dialysis patient-year averaged $63,340, or 9.8% higher than the corrected estimate from the U.S. Renal Data Service (USRDS; $57,660). The "most expensive" 25% of patients engendered 44 to 48% of the total costs, and inpatient costs accounted for 37 to 40% of total costs. Nearly half of the inpatient costs resulted from only two categories (room charges and inpatient dialysis), whereas other categories each made up a small fraction of the inpatient costs. PD patients were far less expensive to care for than HD patients, due to reduced hospital days and lower cost of outpatient dialysis. Care for a university-based dialysis population was only slightly more expensive than estimates predicted from the USRDS. These results validate the USRDS spending data and suggest that they can be used effectively for setting capitated rates. Efforts to control costs without sacrificing quality of care must center on reducing inpatient costs, particularly room charges and the cost of inpatient dialysis.

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Journal of the American Society of Nephrology
Vol. 9, Issue 5
1 May 1998
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The cost of caring for end-stage kidney disease patients: an analysis based on hospital financial transaction records.
F J Bruns, P Seddon, M Saul, M L Zeidel
JASN May 1998, 9 (5) 884-890;

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The cost of caring for end-stage kidney disease patients: an analysis based on hospital financial transaction records.
F J Bruns, P Seddon, M Saul, M L Zeidel
JASN May 1998, 9 (5) 884-890;
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Cited By...

  • Out-of-pocket costs and productivity losses in haemodialysis and peritoneal dialysis from a patient interview survey in Taiwan
  • Medicares New Prospective Payment System on Facility Provision of Peritoneal Dialysis
  • Peritoneal Dialysis First: Rationale
  • Hospital Resource Utilization That Occurs with, Rather than Because of, Kidney Failure in Patients with End-Stage Renal Disease
  • End-Stage Renal Disease-Associated Managed Care Costs Among Patients With and Without Diabetes
  • Kidney Transplantation in the Elderly: A Decision Analysis
  • Peritoneal Dialysis in the 21st Century: An Analysis of Current Problems and Future Developments
  • Maintenance Dialysis Population Dynamics: Current Trends and Long-Term Implications
  • Hospital Utilization among Chronic Dialysis Patients
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