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Impact of a Cleft and Craniofacial Center on the Health Care System
Navid Pourtaheri MD PhD, Aaron Kearney, Craig Anderson, David Blankfield, Derrick C. Wan MD, Gregory E. Lakin MD
University Hospitals, Case Western Reserve University
2015-03-09
Presenter: Navid Pourtaheri MD PhD
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting. The entirety of the work on this project represents the original work of the resident, Navid Pourtaheri.
Director Name: Hooman Soltanian, MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Introduction: Given financial pressures in our health care system, physicians must justify allocated resources based on cost-benefit analyses. We hypothesize that a cleft and craniofacial center (CFC) generates profitable downstream productivity for the health system.
Methods: We retrospectively reviewed clinical and financial records of patients who presented to CFC in the first quarter of 2011 and analyzed their subsequent health system encounters over a two-year period. For each encounter we evaluated inpatient/outpatient status, length of stay, attending physician, ancillary clinical services, ICD9 codes, CPT codes, RVUs, payor type, reimbursement, direct and indirect costs.
Results: Sixty-two patients (61.3% male, 38.7% female) were seen in CFC (29.0% new, 71.0% return patients) with ages from 2.7 to 19.5 years (mean 11.4±4.9). Over two years, the 62 patients generated 618 health system encounters, 19 inpatient stays, 68 hospital days, and 112 procedures. Visits involved 32 different physician specialties (51.5% plastic surgery, 22.4% pediatric subspecialties, 12.9% otolaryngology, 13.2% other) and 8 non-physician specialists (256 speech therapy encounters, 71 audiology, 13 physical and occupational therapy, 8 sleep medicine, 8 voice lab, 2 genetics, 2 nutrition). The most common payor type for encounters was Medicaid (60.2% compared to 35.8% managed care, 2.1% self-pay, 1.6% state disability, and 0.3% Medicare). The gross profit margin was negative for outpatient visits, positive for inpatient stays, and positive overall for all encounters.
Discussion: Our study shows that a comprehensive CFC generates positive financial impact on a health care system through downstream revenue from hospital stays, procedures, and encounters across 40 different specialties.
