SAN FRANCISCO — For every $1 billed by the hepatology section at one institution, the hospital generated an additional $27 in charges, a retrospective study showed.
The data are the first to document why medical centers should support their hepatology sections and their hepatologists in this more consultative and less procedurally oriented specialty, Dr. Donald M. Jensen said at the annual meeting of the American Association for the Study of Liver Diseases.
The study was prompted by Dr. Jensen's experience of having to justify budgets and salaries in his hepatology section to hospital administrators—who focused mainly on practice-generated revenue and not downstream revenue.
“Every year I'd have to go through this genuflecting about why we're not generating more revenue,” said Dr. Jensen, who coauthored the study while at Rush University, Chicago, and now is the director of the center for liver diseases at the University of Chicago Hospitals. Dr. Stanley M. Cohen of Rush University was lead author of the study (Hepatology 2005;41:968–75).
The investigators analyzed data on new outpatient consultations and initial admissions over a 3-month period for 179 patients in the hepatology section and 179 patients in the gastroenterology section, who were followed for 12 months.
They calculated both direct charges (generated directly to the sections) and indirect charges (generated to the hospital system). The hepatology section had 3 full-time physicians, whereas the gastroenterology section had 7.5 full-time physicians.
In total, the hepatology section generated nearly $5.9 million in charges for the hospital, compared with $2.3 million generated by gastroenterology. Direct charges accounted for 4% of charges from hepatology and 16% of charges from gastroenterology. The mean charge per patient was $32,090 for hepatology patients and $12,700 for gastroenterology patients, he said.
Compared with the $27 generated for the hospital for every $1 charged to hepatology, in gastroenterology every $1 charged generated an additional $5 in charges for the hospital. Among the hepatology patients, 9 of the 179 underwent orthotopic liver transplant during the study period. These patients generated 64% of the hepatology revenues, 98% of which were hospital charges.
Every $1 charged to hepatology for the transplant patients generated an additional $51 for the hospital. Even without the transplant patients, every $1 in hepatology charges generated $14 in downstream charges, Dr. Jensen noted.
That compares favorably with previous data from studies of other specialties that do not rely heavily on procedures, he added. A study of primary care services found that every $1 in direct charges generated $7 in indirect charges for the hospital. “Hepatology was clearly above that range,” Dr. Jensen said. One limitation of the study is that the gastroenterology section at Rush University Medical Center sees more than twice as many patients as does the hepatology section during a 3-month period, he added.