DDHA 9901 Week 6 Cost Estimate Example

What the Late Discharge Summary Costs Each Year as Things Stand: A Traceable Estimate Built Link by Link, Reported as a Range, With the Unpriced Costs Kept Separate

Student Name

Walden University

DDHA 9901: Practice-Based Problem Identification

Instructor Name

Month Day, Year

What the Late Discharge Summary Costs Each Year as Things Stand: A Traceable Estimate Built Link by Link, Reported as a Range, With the Unpriced Costs Kept Separate

What Is Being Priced

This estimate puts a figure on the discharge summary transmission problem at Larchmont Health, a composite two-hospital system, as it currently runs. It prices no solution. Every link in the chain is shown, each unit cost is attributed in the sentence that uses it, and frequencies come from the evidence gathered earlier in the course rather than from recollection. Because the inputs are uncertain, the result is a range.

Frequency

The chain starts with how often the problem occurs. Larchmont discharges about 8,600 adult medical patients home each year, from the record system's discharge counts. About 55% of them are followed by a practice that does not use Larchmont's record, roughly 4,730 discharges. In the months when both transmission logs were available, the summary reached the practice within two business days for 52% of those discharges, so about 48%, roughly 2,270 discharges a year, are not transmitted in time. A further group, about 520 a year, have no primary care clinician recorded, so their summaries go nowhere; they are counted separately below.

Unit Costs

Labor costs use national wage data. The median hourly wage for medical secretaries and administrative assistants was $22.08 in the most recent national estimates, for physician assistants $65.33 and for the category of physicians that includes hospitalists $127.85 (U.S. Bureau of Labor Statistics, 2026). These are wages, not fully loaded costs, so they understate the true cost of staff time; the estimate uses them as the lower bound and adds 30% for benefits as the upper bound.

Category 1: Practice Staff Chasing Missing Summaries

When a summary has not arrived, practice staff often call or fax the hospital to request it. The share of late summaries that trigger a request is an assumption, set at 50% to 70%, because practices were not surveyed; the physician liaison's account of repeated complaints supports a figure in that range. Each request takes an assumed 15 to 25 minutes of a medical secretary's time, including waiting on hold and filing what arrives. Combining these with the wage, loaded at the upper bound, gives about $6,300 to $19,000 a year. This cost falls on the practices, not on Larchmont, but it is a real cost of the problem as it runs.

Category 2: Hospital Staff Answering Requests

Each request has to be answered at the hospital, usually by health information management staff or unit clerks who locate and resend the summary. At an assumed 8 to 12 minutes per request and the same wage, this comes to about $3,300 to $9,100 a year, falling on Larchmont.

Category 3: Clinician Time at the Follow-Up Visit

When a summary is missing at the visit, the clinician spends time reconstructing what happened from the patient, the pharmacy and calls to the hospital. The matched data suggest that about 60% of patients whose summaries were late had a follow-up visit within 14 days, about 1,360 visits a year. Assuming 8 to 15 additional minutes per visit, valued at the physician assistant wage at the low end and the loaded physician wage at the high end, gives about $11,900 to $56,600 a year, depending on who sees the patient and how long the reconstruction takes. This is the largest priced category and the most uncertain.

Category 4: Discharges With No Clinician Recorded

For the roughly 520 discharges a year with no primary care clinician recorded, the summary is never sent. Some of these patients have no clinician; others have one whom registration failed to record. Their follow-up costs are not priced here because the share who have a clinician is unknown, but the category is kept separate so it is not lost.

The Assumption Block

Table 1

Assumptions Behind the Estimate

Wages are national medians from the Bureau of Labor Statistics; changing any assumption changes the corresponding category and nothing else.

The Annual Range

Adding the three priced categories gives about $21,500 to $84,700 a year in staff and clinician time, most of it falling on the outside practices, whose staff and clinicians absorb the first and third categories. The figure is modest, and it is presented as a range because a single number would imply a precision the assumptions do not support.

Costs Left Unpriced

Two costs are larger in principle and are deliberately not priced. The first is readmissions. Maryland data tie late completion to more readmissions (Hoyer et al., 2016), and Ontario patients whose clinician had the summary in hand were readmitted somewhat less often, a difference too small to be statistically reliable (van Walraven et al., 2002). Neither study isolates transmission, and neither supports an attributable fraction that could be applied to Larchmont's readmissions without inventing precision. The second is the accountable care relationship: practices that repeatedly see patients without summaries may weaken their participation, which could cost shared savings. Both are named so a reader knows they exist, and neither is added to the total.

What the Estimate Supports

The priced cost is not large enough on its own to justify a major purchase, which is itself a useful finding for an organization that had begun shopping for a platform. Its main value is in showing where the time is lost, at practices and at visits, and in separating the measurable cost from the unpriced risks that make the problem matter.

References

Hoyer, E. H., Odonkor, C. A., Bhatia, S. N., Leung, C., Deutschendorf, A., & Brotman, D. J. (2016). Association between days to complete inpatient discharge summaries with all-payer hospital readmissions in Maryland. Journal of Hospital Medicine, 11(6), 393-400. https://doi.org/10.1002/jhm.2556

U.S. Bureau of Labor Statistics. (2026). Occupational employment and wage statistics: National estimates for occupations 43-6013, 29-1071 and 29-1229 [Data set]. https://www.bls.gov/oes/

van Walraven, C., Seth, R., Austin, P. C., & Laupacis, A. (2002). Effect of discharge summary availability during post-discharge visits on hospital readmission. Journal of General Internal Medicine, 17(3), 186-192. https://doi.org/10.1046/j.1525-1497.2002.10741.x