Englesbe M J, Ads Y, Cohn J A, Sonnenday C J, Lynch R, Sung R S, Pelletier S J, Birkmeyer J D, Punch J D
Michigan Surgical Collaborative for Outcomes Research and Evaluation, Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
Am J Transplant. 2008 Mar;8(3):586-92. doi: 10.1111/j.1600-6143.2007.02098.x.
Over the past several years we have noted a marked decrease in this profitability of our kidney transplant program. Our hypothesis is that this reduction in kidney transplant institutional profitability is related to aggressive donor and recipient practices. The study population included all adults with Medicare insurance who received a kidney transplant at our center between 1999 and 2005. Adopting the hospital perspective, multi-variate linear regression models to determine the independent effects of donor and recipient characteristics and era effects on total reimbursements and total hospital margin. We note statistically significant decreased medical center incremental margins in cases with ECDs (-$5887) and in cases of DGF (-4937). We also note an annual change in the medical center margin is independently associated with year and changes at a rate of -$5278 per year, related to both increasing costs and decreasing Medicare reimbursements. The financial loss associated with patient DGF and the use of ECD kidneys may resonate with other centers, and could hinder efforts to expand kidney transplantation within the United States. The Centers for Medicare and Medicaid Services (CMS) should consider risk-adjusted reimbursement for kidney transplantation.
在过去几年中，我们注意到肾脏移植项目的盈利能力显著下降。我们的假设是，肾脏移植机构盈利能力的下降与积极的供体和受体操作有关。研究人群包括1999年至2005年间在我们中心接受肾脏移植的所有有医疗保险的成年人。从医院角度出发，采用多变量线性回归模型来确定供体和受体特征以及时代效应对总报销额和医院总利润的独立影响。我们注意到，在使用扩展标准供体（ECD）的病例中，医疗中心的增量利润有统计学意义的下降（-$5887），在发生移植肾功能延迟恢复（DGF）的病例中也是如此（-$4937）。我们还注意到，医疗中心利润的年度变化与年份独立相关，且以每年-$5278的速度变化，这与成本增加和医疗保险报销减少都有关。与患者发生DGF以及使用ECD肾脏相关的财务损失可能在其他中心也存在，并且可能阻碍美国境内肾脏移植的扩展努力。医疗保险和医疗补助服务中心（CMS）应考虑对肾脏移植进行风险调整后的报销。
