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 journalArticlepeer-review

3 Scopus citations


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
Issue number6
StatePublished - Dec 1 1995
Externally publishedYes

ASJC Scopus subject areas

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


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