Home parenteral nutrition under an activity based funding model-An Australian costing study.

Abstract

Aim: There is limited understanding about the cost of managing individuals requiring home parenteral nutrition within an outpatient setting. This study aimed to quantify healthcare costs of managing home parenteral nutrition (at-home and within the multidisciplinary outpatient clinic setting) and compare incurred costs against an activity-based funding model.

Methods: A 12-month retrospective study compared parenteral nutrition at-home costs and outpatient clinic costs to funding reimbursement. Costing data were retrieved from electronic medical records and monthly hospital finance reports for 28 individuals that required home parenteral nutrition at a quaternary hospital in Sydney, Australia. Hospital remuneration was calculated. Data are presented as median and range.

Results: Individuals on home parenteral nutrition attended a median (range) of 4 (3-7) multidisciplinary outpatient appointments over the year, where one outpatient appointment cost AU$294.51, less than the reimbursement of AU$366.37 based on the funding model allowing for medical billing; and AU$560.55 for activity-based funding where additional loading was added for multidisciplinary input. The median at-home costs per individual per month were AU$6949.86 (AU$2951.64 to AU$15015.77), compared to the funding model reimbursement of AU$7374.64 per individual per month.

Conclusions: The current healthcare funding model sufficiently covers home parenteral nutrition multidisciplinary outpatient service costs as well as at-home costs within this single-site study. This is likely due to the routine use of ready-to-hang 3-in-1 parenteral nutrition solutions. Further multicentre research is needed to better understand funding, corroborate the findings of this study, and inform future funding revisions.