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. 2009 May;9(5):1108-14.
doi: 10.1111/j.1600-6143.2009.02592.x.

Case mix, quality and high-cost kidney transplant patients

M J Englesbe  1 , J B Dimick, Z Fan, O Baser, J D Birkmeyer
Affiliations

Case mix, quality and high-cost kidney transplant patients

M J Englesbe et al. Am J Transplant. 2009 May.

Abstract

A better understanding of high-cost kidney transplant patients would be useful for informing value-based purchasing strategies by payers. This retrospective cohort study was based on the Medicare Provider Analysis and Review (MEDPAR) files from 2003 to 2006. The focus of this analysis was high-cost kidney transplant patients (patients that qualified for Medicare outlier payments and 30-day readmission payments). Using regression techniques, we explored relationships between high-cost kidney transplant patients, center-specific case mix, and center quality. Among 43 393 kidney transplants in Medicare recipients, 35.2% were categorized as high-cost patients. These payments represented 20% of total Medicare payments for kidney transplantation and exceeded $200 million over the study period. Case mix was associated with these payments and was an important factor underlying variation in hospital payments high-cost patients. Hospital quality was also a strong determinant of future Medicare payments for high-cost patients. Compared to high-quality centers, low-quality centers cost Medicare an additional $1185 per kidney transplant. Payments for high-cost patients represent a significant proportion of the total costs of kidney transplant surgical care. Quality improvement may be an important strategy for reducing the costs of kidney transplantation.

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Figures

Figure 1
Figure 1. The proportion of total costs attributable to high-cost patients; the distribution across US hospitals
Figure 2
Figure 2. The relationship between kidney hospital-specific case mix, quality and the proportion of cases which qualify for payments for high-cost patients across US hospitals
For comparisons of case mix, *indicates p < 0.001 compared to hospitals with a high case mix risk profile. For comparisons of hospital quality, *indicates p < 0.001 compared to hospitals with low measures of quality.
Figure 3
Figure 3. The relationship between kidney hospital-specific case mix, quality and the proportion of hospital reimbursement from payments for high-cost patients across US hospitals
For comparisons of case mix, * indicates p < 0.001 compared to hospitals with high-risk case mix risk profile. For comparisons of hospital quality, * indicates p < 0.001 compared to hospitals with low measures of quality
See this image and copyright information in PMC

Comment in

  • The cost and quality paradox.
    Axelrod DA, Lentine KL, Salvalaggio PR, Schnitzler MA. Axelrod DA, et al. Am J Transplant. 2009 May;9(5):985-6. doi: 10.1111/j.1600-6143.2009.02600.x. Am J Transplant. 2009. PMID: 19422326 No abstract available.

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