Joint Venture Analysis for a Combined Acute/Chronic Hemodialysis Clinic at Tripler Army Medical Center

摘要

The objective of this study was to determine the cost effectiveness and strategic implications of expanding the existing dialysis clinic at Tripler Army Medical Center (TAMC), Oahu, Hawaii, to allow Veterans Administration (VA) beneficiaries access for chronic dialysis care. The study analyzed the costs incurred by the Spark M. Matsunaga Veteran's Administration Medical and Regional Office Center (VAMROC) during FY2002 at private dialysis facilities and at TAMC. The VAMROC provides a broad range of primary medical care services and veteran's benefits, serving an estimated 127,600 veterans throughout Hawaii and the Pacific Islands. It also provides outpatient services through an Ambulatory Care Clinic on Oahu and through five community-based outpatient clinics on neighboring islands. However, the VAMROC on Oahu does not have a hemodialysis unit. The majority of its beneficiaries requiring chronic hemodialysis treatment must be referred to private providers on the island. The fixed, variable, direct, and indirect costs for dialysis at the two facilities were analyzed and used to produce cost projection models for an expanded acute/chronic dialysis facility. Step costs for additional staff were built into the models and pharmaceutical cost projections were estimated based on historical data. The study indicated that it is in TAMC's best interest to focus on related diversification and expand to meet the chronic dialysis needs of the VA beneficiaries. Financially, through this project, TAMC would be able to significantly reduce its dialysis treatment costs and provide a competitive market price while simultaneously exceeding the other island dialysis providers' staffing ratios and skill sets. Based on the results of this study, it is recommended that a Joint Venture Acute/Chronic Hemodialysis Clinic staffed to support 28 chronic plus 4 acute/inpatient beneficiaries be initiated. (3 figures, 38 refs.).