Who Pays for Biliary Complications Following L TX? A Business Case for Quality Improvement

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Who

Pays for Biliary Complications Following Liver Transplant? A

Business Case for Quality Improvement

Authors:

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.; , D. A.

Source:

American Journal

of Transplantation, Volume 6, Number 12,

December 2006, pp. 2978-2982(5)

Abstract:

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.