Development of a continuous renal replacement program in critically ill patients.

Background: Critically ill patients encounter many obstacles, such as acute renal failure, that increases length of stay as well as hospital cost. Dialysis in these patients is often ineffective thereby prolonging the inevitable and significantly increasing the cost of care. A dialysis program that could improve patient care, potentially improve outcome and be "revenue neutral" would be ideal.

Methods: A continuous renal replacement therapy (CRRT) program was developed to significantly impact the care of critically ill patients Using the latest CRRT equipment along with an innovative hands-on CRRT training program, a specialized CRRT team was created. Working in conjunction with the hospital business office, new revenue charge codes were created and existing codes were updated. Patients who underwent CRRT had their financial records reviewed for: hospital cost to perform CRRT, total hospital billing to the payer, CRRT revenue 881 (billing units) charged to the payer, total charges and reimbursement for the account, percentage of reimbursement, collected revenue, and payer.

Results: From April 2000 to February 2002, 39 critically ill patients underwent CRRT. Initial set-up cost was US$79,622.80 and the cost of CRRT was US$222,323.98. The hospital billed for US$656,090.63 and assuming 100% reimbursement, the potential profit was US$427,678.50. However, loss of revenue, mainly from noncompliance with charge capture resulted in the hospital billing only US$386,794.32 with a total reimbursement of US$165,779.86. The 21 burn patients who underwent CRRT yielded a net profit of US$10,294.12, with the highest reimbursement from workman's compensation and private payers. The overall mortality rate was 59% and 65% for the burn patients; significantly lower than published national averages.

Conclusions: An in-house CRRT program improved patient care by providing dialysis in patients who normally would not tolerate the procedure. Although there was a loss of revenue, CRRT in the burn patients appeared "revenue neutral." Although not specifically studied in this review, based on published data, mortality rates in this population were lower than expected especially in critically ill burn patients.