Hemoglobinopathy as a whole affects approximately 1.5% of Americans. Sickle Cell Disease (SCD) affects over 100,000 people in the United States and disproportionately affects African-Americans specifically. In addition to pain crises, those with SCD can experience a variety of complications, including chronic anemia, stroke, kidney disease, avascular necrosis of the humeral and femoral heads, priapism, and pulmonary hypertension. Due to functional asplenia and recurrent transfusions, many patients often develop hemolytic auto-antibodies, further worsening their anemia. All of this co-occurs with and perhaps even fuels depression, anxiety, and substance use disorders in these patients. As a result, there is a great unmet need for proper sickle cell management in those centers with many affected patients.

Conventional management of SCD involves allowing the patient to present to either their clinic or the emergency room and await triage. This system is often inadequate as the patient is often unable to secure an appointment in a timely manner in the outpatient setting, and the patient is often managed by those unfamiliar with sickle cell management in the emergency setting. This results in unnecessary blood transfusions, pain medication use, and inappropriately long length of stay. This leads to increased operating costs for the hospital, often with no benefit to the patient. In June of 2024, Howard University debuted the Sickle Cell Wellness Center. The Center was purpose-built to provide same-day care to sickle cell patients to reduce the severity of pain crises and decrease the rate of presentation to the ED. This project explores the performance of the Center with regard to reducing admissions and improving reimbursement rates.

A random sample of 10 patients was generated from de-identified data encompassing sickle cell patients who presented to Howard University Hospital in the inpatient and outpatient settings. The total number of claims was quantified for the sample on a de-identified per-patient basis and collectively. The percentage of claims reimbursed was calculated for the emergency, inpatient, and Sickle Cell Wellness Center settings. These numbers were compared to calculate a relative increase (or decrease) in billing percentage and compare the efficacy of the respective settings in appropriate reimbursement. Sickle cell inpatient prevalence was calculated by proxy using the number of hospital days with a sickle cell patient present.

Prior to the establishment of the Sickle Cell Wellness Center, reimbursement rates for sickle cell disease management were relatively similar across care settings over three fiscal years. During this period, the average reimbursement rate was 19% for ED-managed SCD patients, 30% for outpatient services, and 34% for inpatient care. Following the launch of the Sickle Cell Wellness Center, the reimbursement rate for SCD patients utilizing its service increased to 46%, compared to 27% for those managed through ED services and 28% for inpatient care during the same fiscal year. The percentage of inpatient days with a sickle cell patient present was reduced from 86% to 46% following the introduction of the Sickle Cell Wellness Center.

As noted above, the introduction of the Wellness Center vastly improved the rate of claims reimbursed. This is likely reflective of the fact that the Wellness Center is more optimally positioned to provide care that is both timely and appropriate when compared to the time-constrained clinic setting and the skill-constrained emergency room setting. Further research is needed regarding the influence of the center on opioid pain medication use, as a major predisposing factor to emergency room presentation is a lack of pain medication availability. Further research can also explore the benefits for mental health resources for reducing the rate of sickle cell complications and hospitalization rates.

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2025
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