Philip L Henneman1, Brian H Nathanson2, Kara Ribeiro3, Hari Balasubramanian3. 1. Baystate Medical Center, Springfield, MA; Tufts University School of Medicine, Boston, MA. Electronic address: philip.henneman@bhs.org. 2. Optistatim, LLC. Longmeadow, MA. 3. University of Massachusetts, Amherst, MA.
Abstract
OBJECTIVE: To determine how age and gender impact resource utilization and profitability in patients seen and released from an Emergency Department (ED). METHODS: Billing data for patients seen and released from an Emergency Department (ED) with >100,000 annual visits between 2003 and 2009 were collected. Resource utilization was measured by length of stay (placement in ED bed to leaving the bed) and direct clinical costs (e.g., ED nursing salary and benefits, pharmacy and supply costs, etc.) estimated using relative value unit cost accounting. The primary outcome of profitability was defined as contribution margin per hour. A patient's contribution margin by insurance type (excluding self-pay) was determined by subtracting direct clinical costs from facility contractual revenue. Results are expressed as medians and US dollars. RESULTS: In 523 882 outpatient ED encounters, as patients' aged, length of stay and direct clinical cost increased while the contribution margin and contribution margin by hour decreased. Women of childbearing age (15-44) had higher median length of stay (2.1 hours), direct clinical cost ($149), and contribution margin per hour ($103/hour) than men of same age (1.7, $131, $85/hour, respectively). Resource utilization and profitability by gender were similar in children and adults over 45. CONCLUSION: Resource utilization increased and profitability decreased with increasing age in patients seen and released from an ED. The care of women of childbearing age resulted in higher resource utilization and higher profitability than men of the same age. No differences in resource utilization or profitability by gender were observed in children and adults over 45.
OBJECTIVE: To determine how age and gender impact resource utilization and profitability in patients seen and released from an Emergency Department (ED). METHODS: Billing data for patients seen and released from an Emergency Department (ED) with >100,000 annual visits between 2003 and 2009 were collected. Resource utilization was measured by length of stay (placement in ED bed to leaving the bed) and direct clinical costs (e.g., ED nursing salary and benefits, pharmacy and supply costs, etc.) estimated using relative value unit cost accounting. The primary outcome of profitability was defined as contribution margin per hour. A patient's contribution margin by insurance type (excluding self-pay) was determined by subtracting direct clinical costs from facility contractual revenue. Results are expressed as medians and US dollars. RESULTS: In 523 882 outpatient ED encounters, as patients' aged, length of stay and direct clinical cost increased while the contribution margin and contribution margin by hour decreased. Women of childbearing age (15-44) had higher median length of stay (2.1 hours), direct clinical cost ($149), and contribution margin per hour ($103/hour) than men of same age (1.7, $131, $85/hour, respectively). Resource utilization and profitability by gender were similar in children and adults over 45. CONCLUSION: Resource utilization increased and profitability decreased with increasing age in patients seen and released from an ED. The care of women of childbearing age resulted in higher resource utilization and higher profitability than men of the same age. No differences in resource utilization or profitability by gender were observed in children and adults over 45.
Authors: Joany M Zachariasse; Dorine M Borensztajn; Daan Nieboer; Claudio F Alves; Susanne Greber-Platzer; Claudia M G Keyzer-Dekker; Ian K Maconochie; Ewout W Steyerberg; Frank J Smit; Henriëtte A Moll Journal: BMJ Open Date: 2020-09-17 Impact factor: 2.692