The Impact of “Emergency-only” Hemodialysis on Hospital Cost and Resource Utilization
Introduction: Undocumented immigrants are excluded from benefits that help compensate for scheduled outpatient hemodialysis (HD), compelling them to use emergency departments (ED) for HD. Consequently, these patients can receive “emergency-only” HD after presenting to the ED with critical illness du...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
eScholarship Publishing, University of California
2023-03-01
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| Series: | Western Journal of Emergency Medicine |
| Online Access: | https://escholarship.org/uc/item/9cj696ss |
| _version_ | 1827977808998039552 |
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| author | Farina Shafqat Shamie Das Matthew A. Wheatley Lauren Kasper Sarah Johnson Stephen R. Pitts Michael A. Ross |
| author_facet | Farina Shafqat Shamie Das Matthew A. Wheatley Lauren Kasper Sarah Johnson Stephen R. Pitts Michael A. Ross |
| author_sort | Farina Shafqat |
| collection | DOAJ |
| description | Introduction: Undocumented immigrants are excluded from benefits that help compensate for scheduled outpatient hemodialysis (HD), compelling them to use emergency departments (ED) for HD. Consequently, these patients can receive “emergency-only” HD after presenting to the ED with critical illness due to untimely dialysis. Our objective was to describe the impact of emergency-only HD on hospital cost and resource utilization in a large academic health system that includes public and private hospitals. Methods: This retrospective observational study of health and accounting records took place at five teaching hospitals (one public, four private) over 24 consecutive months from January 2019 to December 2020. All patients had emergency and/or observation visits, renal failure codes (International Classification of Diseases, 10th Rev, Clinical Modification), emergency HD procedure codes, and an insurance status of “self-pay.” Primary outcomes included frequency of visits, total cost, and length of stay (LOS) in the observation unit. Secondary objectives included evaluating the variation in resource use between persons and comparing these metrics between the private and public hospitals. Results: A total of 15,682 emergency-only HD visits were made by 214 unique persons, for an average of 36.6 visits per person per year. The average cost per visit was $1,363, for an annual total cost of $10.7 million. The average LOS was 11.4 hours. This resulted in 89,027 observation-hours annually, or 3,709 observation-days. The public hospital dialyzed more patients compared to the private hospitals, especially due to repeat visits by the same persons. Conclusion: Health policies that limit hemodialysis of uninsured patients to the ED are associated with high healthcare costs and a misuse of limited ED and hospital resources. |
| first_indexed | 2024-04-09T21:12:14Z |
| format | Article |
| id | doaj.art-9da1d81ce54a4d56856616375a49883a |
| institution | Directory Open Access Journal |
| issn | 1936-9018 |
| language | English |
| last_indexed | 2024-04-09T21:12:14Z |
| publishDate | 2023-03-01 |
| publisher | eScholarship Publishing, University of California |
| record_format | Article |
| series | Western Journal of Emergency Medicine |
| spelling | doaj.art-9da1d81ce54a4d56856616375a49883a2023-03-28T15:41:40ZengeScholarship Publishing, University of CaliforniaWestern Journal of Emergency Medicine1936-90182023-03-0124210.5811/westjem.2022.11.58360wjem-24-206The Impact of “Emergency-only” Hemodialysis on Hospital Cost and Resource UtilizationFarina Shafqat0Shamie Das1Matthew A. Wheatley2Lauren Kasper3Sarah Johnson4Stephen R. Pitts5Michael A. Ross6Emory University, Department of Emergency Medicine, Atlanta, GeorgiaEmory University, Department of Emergency Medicine, Atlanta, GeorgiaEmory University, Department of Emergency Medicine, Atlanta, GeorgiaEmory University, Department of Emergency Medicine, Atlanta, GeorgiaEmory University, Department of Emergency Medicine, Atlanta, GeorgiaEmory University, Department of Emergency Medicine, Atlanta, GeorgiaEmory University, Department of Emergency Medicine, Atlanta, GeorgiaIntroduction: Undocumented immigrants are excluded from benefits that help compensate for scheduled outpatient hemodialysis (HD), compelling them to use emergency departments (ED) for HD. Consequently, these patients can receive “emergency-only” HD after presenting to the ED with critical illness due to untimely dialysis. Our objective was to describe the impact of emergency-only HD on hospital cost and resource utilization in a large academic health system that includes public and private hospitals. Methods: This retrospective observational study of health and accounting records took place at five teaching hospitals (one public, four private) over 24 consecutive months from January 2019 to December 2020. All patients had emergency and/or observation visits, renal failure codes (International Classification of Diseases, 10th Rev, Clinical Modification), emergency HD procedure codes, and an insurance status of “self-pay.” Primary outcomes included frequency of visits, total cost, and length of stay (LOS) in the observation unit. Secondary objectives included evaluating the variation in resource use between persons and comparing these metrics between the private and public hospitals. Results: A total of 15,682 emergency-only HD visits were made by 214 unique persons, for an average of 36.6 visits per person per year. The average cost per visit was $1,363, for an annual total cost of $10.7 million. The average LOS was 11.4 hours. This resulted in 89,027 observation-hours annually, or 3,709 observation-days. The public hospital dialyzed more patients compared to the private hospitals, especially due to repeat visits by the same persons. Conclusion: Health policies that limit hemodialysis of uninsured patients to the ED are associated with high healthcare costs and a misuse of limited ED and hospital resources.https://escholarship.org/uc/item/9cj696ss |
| spellingShingle | Farina Shafqat Shamie Das Matthew A. Wheatley Lauren Kasper Sarah Johnson Stephen R. Pitts Michael A. Ross The Impact of “Emergency-only” Hemodialysis on Hospital Cost and Resource Utilization Western Journal of Emergency Medicine |
| title | The Impact of “Emergency-only” Hemodialysis on Hospital Cost and Resource Utilization |
| title_full | The Impact of “Emergency-only” Hemodialysis on Hospital Cost and Resource Utilization |
| title_fullStr | The Impact of “Emergency-only” Hemodialysis on Hospital Cost and Resource Utilization |
| title_full_unstemmed | The Impact of “Emergency-only” Hemodialysis on Hospital Cost and Resource Utilization |
| title_short | The Impact of “Emergency-only” Hemodialysis on Hospital Cost and Resource Utilization |
| title_sort | impact of emergency only hemodialysis on hospital cost and resource utilization |
| url | https://escholarship.org/uc/item/9cj696ss |
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