A Cost Benefit analysis of medical hospital readmissions comparing patient groups referred to the Partnership for Health Program clinic in Lowndes County Georgia from South Georgia Medical Center Valdosta Georgia under a collaborative primary care transition plan(DTP) for uninsured working Adult patients below 200% Federal Poverty Level. Pubblico
Agbali, Raphael A. (2014)
Abstract
Abstract
A Cost Benefit analysis of medical hospital readmissions comparing patient groups referred to the Partnership for Health Program clinic in Lowndes County Georgia from the South Georgia Medical Center under a collaborative primary care transition plan(DTP) for uninsured working Adults below 200% Federal Poverty Level.
BY
RAPHAEL AYEGBA AGBALI R.Ph
Hospital discharge to community level primary health transition planning has been increasingly identified as a potentially modifiable area for healthcare outcomes improvement. Benefits and costs of a free clinic program from societal perspective are frequently taken for granted as charitable safety nets.
The US healthcare environment is undergoing rapid change and different stakeholders strive to project into the future with some degree of certainty. Economic evaluations help illuminate viable interventions in this setting.
Methods: This study utilized referral log and aggregate medical recent hospitalization data from the Partnership Health Clinic to compare post referral costs and benefits between patients who enrolled in free clinic care and non-adherent patients who did not enroll. 30 day all cause readmission was the clinical measure. Both groups had no insurance and no primary care physician. Readmission costs were estimated using the uninsured dataset of the Healthcare Utilization project (HCUP) database for 2011 then matched to actual length of stay for each study group. cost to charge ratios from MedPAR were used to obtain real life estimates.Household income data for Lowndes County were obtained from the US Census fact finder and clinic transportation estimated from the Georgia non-emergency medical workers compensation transportation allowable rates 2013.
Results: Total referred patient sample was 58 (Clinic enrolled= 26; non-enrolled=32). Net cost of prevented readmission was $16,377.12 for the enrolled patient group with a net financial benefit of $3,890.9 compared to the non-enrolled group (p=0.49). Net difference in hospital length of stay between groups was 25 days while the baseline readmission rate was found to be 25.86 % with readmission rate in the non-enrolled was 34.37%.
Summary: A collaborative discharge transition plan between the South Georgia Medical Center and the charitable Partnership Health Clinic in Valdosta, Georgia generates cost savings to society. Increased enrollment has the capacity to further lower fixed costs, generating future savings to society.
Table of Contents
TABLE OF CONTENTS
CHAPTER 1: INTRODUCTION1
Public Health Problem1 Role of Free Clinics 2 Partnership Clinic 3 Study Purpose 4 Baseline Practices 5 Intervention 5 Questions to be answered by the Economic Evaluation 6 Definition of Terms7
CHAPTER 2: LITERATURE REVIEW 8
Introduction 8
Body 8
Uninsured Status 9
Readmissions11
Location12
SGMC Practices________________________________________________________13
CHAPTER 3: METHODOLOGY16
Introduction 16
Population and Sample 17 Population 17
Sample 17
Methodological Framework 18
Design 19 Analytic Horizon 18
Case Definition19
Costs (PHC enrolled) 19
Costs (PHC non enrolled) 20
Data Dictionary and Plan ___ 21
Cost Estimation methods ___ 21
Costs (Non-emergency Transport to and fro clinic) __ 23
Market price adjustment_________________________________________________ 23
Costs: Lost Income______________________________________________________ 23
Costs: Referral Costs_____________________________________________________ 23
Costs: Clinic encounter generated __________________________________________ 24
Benefits Estimation 25
General Cost Assumptions 26
Methodological process ___26
Data Collection 30
Hospitalization Data ___30
Clinic encounter data ___30
Cost capture methodology ___31
Data analysis plan ___33
Data definition ___34
Benefits (Denominator) ___35
Data Dictionary and worksheet ___36
Calculations for Costs and Benefits ___40
Group Analysis ___41
CHAPTER 4: RESULTS 41
Introduction 41
Findings- Demographics and distribution 41
Healthcare measures : results 42
Tangible Costs-Partnership health Clinic 47
Tangible Costs-Patient Incurred 47
Cost Benefit ratio 48
Marginal Cost-Benefit Ratio 48
Net Benefits 49
Present and Future Valuation 49
The case for or against sensitivity analysis 50
Other Findings 50
CHAPTER 5: CONCLUSION, IMPLICATIONS AND RECOMMENDATIONS ___ 51
Introduction 51
Summary of Study 51 Conclusions Limitations____________________________________________________________ _53
Recommendations for the Partnership Health Clinic 54
Recommendations for Future Studies __ 54
Bibliography __ 55
APPENDIX B: BLS Bureau for Labor provider prevailing wages 60
APPENDIX A: Clinic Expenditures 2013_____________________________________ _61
Table 1. Hospital compare data table SGMC April 2012_March 2013 15
Table 2 Summary of costs by stakeholders 47
Table 3 Benefits and Averted Costs 48
Table 4 Data dictionary and worksheet 37
Table 5 Results: Demographic Distribution 41
Table 6: Re-admission rates and In-between group differences 44
Table 7 Overall benefits in US Dollars: Direct and Indirect 45
Table 8 Combined costs and benefits by group 47
Table 9 Overall cost estimates by stakeholders. 46
Table 10 Present and future value of Hospital costs: 5 year discounted costs 50
LIST OF FIGURESFigure 1.Map of state of Georgia with Lowndes County inset 13
Figure 2. Schematic design 28.
Figure 3. Graph of sample distribution by gender 41
Figure 4 Graph of sample age distribution 41
Figure 5 Graph of sample by race distribution 41
Figure 6 Graph of index admission by month of occurrence 41
Figure 7 Scatter plot of 1st re-admissions by age group (non-enrolled) 42
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