ECONOMIC BURDEN
1
Economic Burden of End Stage Renal Disease
Sarah Turocy
Trends and Issues in Healthcare
Assignment Three: Healthcare Economics
February 20, 2014
ECONOMIC BURDEN
2
Economic Burden of End Stage Renal Disease
The patient I selected to research information about for this paper I will name JD to
protect his privacy since he was a recent patient of mine. JD is a 53 year old male with the
following chronic diseases: End Stage Renal Disease (ESRD), type II diabetes mellitus, and
COPD. He does not require oxygen of any kind on a normal basis. His blood sugars are
controlled by diet and he does not require insulin. For his ESRD, he gets hemodialysis on
Monday, Wednesday, and Friday every week. The reason he was admitted to the unit was for
chest pain that has resolved. He has received dialysis while admitted to the hospital as well as the
medications he normally takes at home. He is also a cigarette smoker of 0.25 packs a day and
occasional marijuana and cocaine user. Also, before admission he had just gotten a great toe
amputation on his left side.
Since this is a patient with co-morbidity, I chose to focus my research on ESRD and the
inpatient costs. A normal hospital patient stay costs $2,170 in the state of Ohio for one day
(Henry J. Kaiser Family Foundation). The patient’s records indicate he normally is funded for his
healthcare and associated costs through Medicare. The Medicare website provides an online
brochure that explains what they cover in association with the costs of kidney dialysis. I am not
sure if JD has Part A or Part B Medicare, but this effects what they will pay for. Also, there is a
plan called Original Medicare that pays for ESRD patients specifically that are new to Medicare
coverage and helps pay for supplies and medications (Medicare 9). One incredible article I found
on the website for the United States Renal Data System (USRDS) states that the average cost for
one ESRD patient per year as of 2011 is $87,945 (USRDS 326). Every year the data shows that
costs increase for ESRD and continue to trend upward (USRDS Figure 11.7).
ECONOMIC BURDEN
For your average ESRD patient, the costs can vary dependent upon whether the patient is
treated inpatient or outpatient for hemodialysis, or receives peritoneal dialysis and what aid is
required. My specific patient, JD, normally has hemodialysis three days a week outpatient.
However, while he is hospitalized he also requires hemodialysis treatment. According to the
USRDS, the solutions and medications used for dialysis cost more in outpatient centers than
inpatient. Since I do not know which Medicare this patient carries, I am not sure what is covered
for him. My guess would be that most of the expense of dialysis is covered for him. Hospitals
then are reimbursed by Medicare for these patients. The only reason I can think of that they
would not reimburse is for infections or injuries/ fatalities caused by healthcare workers. The
DRG reimbursement is based on physician’s diagnosis of the patient. For my patient JD, his code
would be “585.6 End Stage Renal Disease” (AHIMA 10). After a patient is assigned a code,
there are other codes for treatments that can be applied in addition. In this case, the codes would
be for dialysis.
When focusing on my part as a nurse, there are a few things I could do, or my hospital
could do, to decrease costs and still maintain quality care. First and foremost, as with anything I
do as a nurse, safety and infection prevention should be number one. If nurses take the right steps
in providing safe, competent care to patients, then infections, injuries, and fatalities can be
prevented. Secondly, making sure the patient is able to make his dialysis appointments and gets
treatment when needed will reduce costs. In addition, medications need to be available to the
patient. If the patient is unable to get to medications or doesn’t have the means to pay for them,
then nurses could help with getting assistance. Overall, I think the biggest takeaway here is to
focus on prevention and thorough discharge instructions. This will reduce costs for everyone
involved in the patients care while not compromising on quality care.
3
ECONOMIC BURDEN
As a nurse on my unit, I care for renal patients that receive hemodialysis or peritoneal
dialysis, on average, about two to three days per month. This research was interesting to do on a
patient that represents an average patient on my unit. I had no idea the intricate details and
endless coding that goes into reimbursement and payment from Medicare. Now that I am more
informed, it reiterates to me the focus on those basic skills to prevent healthcare associated
infections. It also gives me a broader understanding of what patients might deal with when
getting Medicare and what all it entails. I am thankful these patients receive assistance and that
there is a program available to help them. I cannot imagine what the costs would be if there was
not assistance available.
In conclusion, I think it was an eye opening experience to research what goes into the
costs of patient care and how Medicare reimburses healthcare establishments. One big discovery
I made was that I had only researched one disease and this patient had at least 4 major diseases
among multiple smaller other ones that would have codes of their own. It adds to the complexity
of each patient’s care and how detailed hospitals have to be about what care is given for
reimbursement. From a nursing standpoint, it gives me a greater respect for that system and
reinforces the importance of proper patient care and documentation.
4
ECONOMIC BURDEN
5
References
Lee, H., Manns, B., Taub, K., Ghali, W., Dean, S., Johnson, D., & Donaldson, C. (2002). Cost
analysis of ongoing care of patients with end-stage renal disease: the impact of dialysis modality
and dialyis access. American Journal Of Kidney Diseases, 40(3), 611-622.
Centers for Medicare and Medicaid Services. (2014). Retrieved from
http://www.medicare.gov/Pubs/pdf/10128.pdf
The Henry J Kaiser Family Foundation. (2011). Retrieved from
http://kff.org/other/state-indicator/expenses-per-inpatient-day/
United States Renal Data System. (2013). Retrieved from
http://www.usrds.org/2013/pdf/v2_ch11_13.pdf
AHIMA. (2007). Retrieved from
http://campus.ahima.org/audio/2007/RB031507.pdf