Sg2 analysis finds clinical and financial advantages to outsourcing dialysis services

IRVING, Texas, Feb. 4, 2025 — A recent Sg2 analysis of inpatient dialysis care finds that for some hospitals currently operating in-house dialysis services, outsourcing may offer clinical, operational and financial benefits including shorter lengths of stay, lower infection rates and reduced direct costs. Read “To Outsource or Not? A Correlative Study of In-Hospital Dialysis Outcomes and Costs”.

Inpatient dialysis is one of the most resource-intensive services hospitals provide due to the complexity of the patients and the logistical challenges of its delivery. Two main conditions drive inpatient dialysis: end-stage renal disease (ESRD) and acute kidney injury (AKI). These conditions are not mutually exclusive, as some ESRD patients receiving dialysis in the hospital may also have an AKI. In terms of distribution, 71% of hospital dialysis patients have ESRD only, 7% have an AKI only and 22% have both ESRD and an AKI. Patients with an AKI require intensive interventions due to their higher complexity and reliance on critical care.

Sg2, a Vizient® company, analyzed inpatient outcomes and costs for in-house and outsourced dialysis services for 349,361 patients from 546 hospitals in the Vizient Clinical Data Base. The analysis showed that the observed correlative benefits of outsourcing inpatient dialysis are most evident at higher acuity facilities. On average, when compared with inpatients receiving outsourced dialysis care, in-house dialysis care patients:

• Incur a 10% higher average direct hospitalization costs at academic medical centers ($41,853 vs $37,893)
• Stay more than a day longer in the ICU at high acuity facilities (9.76 vs 8.64)
• Spend an average of two additional days in the hospital at high acuity facilities when diagnosed with AKI (21.85 days vs 19.82)

“With annual AKI and ESRD cases projected to reach nearly 850,000 nationally by 2034, the data highlights the intensive demands of managing this inpatient population,” said Emily Fitt, MHA, MPH, consultant, Sg2. “The analysis suggests that outsourcing dialysis may have clinical and financial advantages, particularly in high-acuity settings like academic medical centers and large, specialized medical centers.”

Sg2 also evaluated high-acuity patient transfer data related to in-house and outsourced dialysis care. The data showed that outsourcing dialysis may be able to improve transfer dynamics by enabling lower-acuity hospitals to retain and manage more inpatient dialysis care locally, which in turn alleviates resource pressure on high-acuity facilities. This balanced approach may allow high-acuity centers to dedicate their resources to managing the most complex cases, enhancing overall health system efficiency.

“These findings give hospital leaders a starting point for collaboration with clinicians to make data driven decisions that can enhance care delivery, lower costs and optimize system-wide resource utilization for dialysis care,” said Fitt.

The outcomes reported in this study represent correlative relationships, not causality. Where possible, Sg2 sought to normalize for differences in case mix index (CMI), which is a metric that reflects the diversity, complexity and severity of the patients treated at a hospital and is based on the average MS-DRG weight for a population of patients. It is important to note that further research is necessary to isolate the specific impact of outsourcing from the confounding effects of variables such as patient demographics, patient complexity, case severity and other hospital-specific factors.

About Sg2
Sg2, a Vizient company, is the health care industry’s trusted partner for accelerating growth and improving financial results. Our analytics and expertise help health care leaders achieve sustainable growth and maintain market relevance by optimizing System of CARE, payer and consumer strategies. Learn more at www.Sg2.com.

About Vizient
Vizient, Inc., the nation's largest provider-driven healthcare performance improvement company, serves more than 65% of the nation's acute care providers, including 97% of the nation's academic medical centers, and more than 35% of the non-acute market. The Vizient contract portfolio represents $140 billion in annual purchasing volume enabling the delivery of cost-effective, high-value care. With its acquisition of Kaufman Hall in 2024, Vizient expanded its advisory services to help providers achieve financial, strategic, clinical and operational excellence. Headquartered in Irving, Texas, Vizient has offices throughout the United States. Learn more at www.vizientinc.com.