Some U.S. hospitals that operate in-house dialysis services might benefit from outsourcing them, as inpatient discharge and length of stay rates increase, according to an analysis from Sg2, a Vizient company.
Due to the country's aging population and a rising prevalence of comorbidities, Sg2 has predicted a 9% jump in inpatient days and a 3% increase in inpatient discharges by 2034.
"[H]ospitals face mounting pressure to manage rising patient volumes," according to the report, released Feb. 4. "Patients who require dialysis already require higher ICU utilization and longer hospital stays, which will put additional strain on staffing, bed capacity and overall operational workflows as these trends continue."
Between 2019 and 2022 alone, rising acuity contributed to a nearly 24% surge in average length of stay.
Since in-house dialysis services require specialized and resource-intensive care, outsourcing might be a viable option for some hospitals facing these operational concerns.
Here are five study findings on the value of in-house and outsourced dialysis services:
1. End-stage renal disease accounts for more than 90% of the inpatient dialysis population, and acute kidney disease represents nearly 30% of inpatient dialysis cases.
2. Patients who require dialysis — especially those with acute kidney disease — have higher ICU utilization, longer lengths of stay and greater costs than non-dialysis patients.
Compared to non-dialysis patients, those on dialysis have nearly twice the ICU utilization rate (31.9% versus 15.4%), stay five days longer in the hospital (10.70 days versus 5.61), see 30-day readmission rates that are twice as high (24.7% versus 12.7%) and incur direct hospitalization costs that are 2.5 times higher ($27,471 versus $11,554).
3. Academic medical centers are particularly susceptible to worsening capacity challenges due to a growing need for intensive care. And these high-acuity hospitals are likely over-relied upon for treating dialysis patient transfers, while low-acuity hospitals in the same health system can be underutilized.
This trend highlights a potential loss of revenue for the overutilized tertiary/quaternary hospital due to constrained capacity.
4. Known indicators that a hospital is struggling with in-house dialysis are inefficient access and service distribution.
5. When examining several clinical measures, AMCs with outsourced dialysis services outperform those with in-house programs. These greater clinical outcomes include shorter length of stay, lower 30-day readmission rates and fewer reported vascular catheter-associated infections.
Although this research suggests a potential benefit of outsourcing dialysis services, Sg2 said further study is needed to account for patient demographics, patient complexity, case severity and other hospital-specific factors.