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Who Pays for Biliary Complications Following Liver Transplant? A Business Case for Quality Improvement
Author(s) -
Englesbe M. J.,
Dimick J.,
Mathur A.,
Ads Y.,
Welling T. H.,
Pelletier S. J.,
Heidt D. G.,
Magee J. C.,
Sung R. S.,
Punch J. D.,
Hanto D. W.,
Campbell D. A.
Publication year - 2006
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/j.1600-6143.2006.01575.x
Subject(s) - medicine , complication , logistic regression , liver transplantation , reimbursement , transplantation , surgery , health care , economics , economic growth
We use biliary complication following liver transplantation to quantify the financial implications of surgical complications and make a case for surgical improvement initiatives as a sound financial investment. We reviewed the medical and financial records of all liver transplant patients at the UMHS between July 1, 2002 and June 30, 2005 (N = 256). The association of donor, transplant, recipient and financial data points was assessed using both univariable (Student's t ‐test, a chi‐square and logistic regression) and multivariable (logistic regression) methods. UMHS made a profit of $6822 ± 39 087 on patients without a biliary complication while taking a loss of $5742 ± 58 242 on patients with a biliary complication (p = 0.04). Reimbursement by the payer was $55 362 higher in patients with a biliary complication compared to patients without a biliary complication (p = 0.001). Using multivariable logistic regression analysis, the two independent risk factors for a negative margin included private insurance (compared to public) (OR 1.88, CI 1.10–3.24, p = 0.022) and biliary leak (OR = 2.09, CI 1.06–4.13, p = 0.034). These findings underscore the important impact of surgical complications on transplant finances. Medical centers have a financial interest in transplant surgical quality improvement, but payers have the most to gain with improved surgical outcomes.