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Impact of a Cleft and Craniofacial Center on a Health Care System
Navid Pourtaheri, M.D., Ph.D1, Aaron Kearney, B.S.2, Craig Anderson, B.A.1, David Blankfield, B.A.1, Derrick C. Wan, M.D.3, Gregory E. Lakin, M.D.1.
1Case Western Reserve University Hospitals, Cleveland, OH, USA, 2Case Western Reserve University School of Medicine, Cleveland, OH, USA, 3Stanford University Medical Center, Palo Alto, CA, USA.

PURPOSE: Given financial pressures in health care, physicians must justify resources based on cost-benefit analyses. We hypothesize that a cleft and craniofacial center (CFC) generates profitable downstream productivity for the health system.
METHODS: To evaluate the impact of patients who presented to CFC in the first quarter of 2011, we followed their health system encounters over a two-year period and studied demographics, primary craniofacial diagnoses, encounter type, length of stay, attending physician, ancillary services, ICD-9 codes, CPT codes, RVUs, charges, payor type, reimbursement, direct and indirect costs.
RESULTS: In the first quarter of 2011, 62 patients (61.3% male, 38.7% female) were seen in CFC (29.0% new, 71.0% return patients). Over two-years they generated 618 health system encounters, 19 inpatient stays, 68 hospital days, and 112 procedures involving 32 different physician specialties (51.5% plastic surgery, 22.4% pediatrics and subspecialties, 12.9% otolaryngology, 13.2% other) and 7 non-physician specialties (256 speech therapy encounters, 71 audiology, 13 physical and occupational therapy, 8 sleep medicine, 8 voice lab, 2 genetics, 2 nutrition). The most common payor per encounter was Medicaid (60.2%, versus 35.8% managed care, 2.1% self-pay, 1.6% state disability, 0.3% Medicare). Only 20.2% of outpatient visits were profitable and generated a -2.8% gross margin whereas 63.2% of inpatient stays were profitable and generated a +24.5% gross margin. The gross profit margin for all health system encounters was +13.7%.
CONCLUSION: A comprehensive CFC generates positive financial impact on a health care system, mainly resulting from inpatient stays, procedures, and clinical services across 39 different specialties.


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