Hospital Resource Utilization That Occurs with, Rather than Because of, Kidney Failure in Patients with End-Stage Renal Disease

More than $18 billion annually is attributed to care of patients with ESRD, with the perception of high renal costs for a relatively small population. It was proposed that accounting methods exaggerate resource utilization that often occurs with rather than because of kidney failure. The dialysis patients in this study had nearly all of their care at university facilities with one financial database. For 1 yr, 112 chronic hemodialysis patients were studied using demographic, insurance, and hospital facility (diagnoses, length of stay, charges, costs, and net income) variables. Substantial inpatient costs and hospitalizations were for nonrenal primary diagnoses, including malignancies, substance abuse, trauma, HIV, and psychiatric diseases: 37% of admissions, 36% of inpatient days, and 32% of charges. Dialysis patients were healthier than indicated by averaged length of stay and cost data, because results were very skewed: Mean 17.3 inpatient days but median only 2.4 d; 43% of patients had 0 to 1 inpatient days (1.3% of charges), 23% had 2 to 7 d (charges 7.6%), 18% had 8 to 30 d (charges 26%), and 16% had >30 d (charges 66%). Lengthy hospitalizations had disproportionately high operating room and respiratory care costs. The large group of relatively healthy outpatients did not avoid hospitalization by high use of facility resources. The true costs for medical care that results from ESRD are not as high as publicized, as a result of misclassification of inpatient expenses from nonrenal comorbidities. When not confounded by analyses that use data means, it is clear that substantial numbers of hemodialysis patients have very brief hospitalizations with low resource utilization.