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Impact of a Cleft and Craniofacial Center on an Academic Health System

Pourtaheri, Navid, M.D., Ph.D.; Kearney, Aaron, B.S.; Wan, Derrick C., M.D.; Lakin, Gregory, M.D.


In the October 2017 Pediatric/Craniofacial article entitled “Impact of a Cleft and Craniofacial Center on an Academic Health System” ( Plast Reconstr Surg . 2017;140:587e–597e), the middle initial for author Gregory E. Lakin, M.D., was missing. The author list should have appeared as “Navid Pourtaheri, M.D., Ph.D., Aaron Kearney, B.S., Derrick C. Wan, M.D., and Gregory E. Lakin, M.D.” The citation on should read as follows: “Pourtaheri N, Kearney A, Wan DC, Lakin GE.”

Plastic and Reconstructive Surgery. 141(5):1313, May 2018.

Plastic and Reconstructive Surgery: October 2017 - Volume 140 - Issue 4 - p 587e-597e
doi: 10.1097/PRS.0000000000003822
Pediatric/Craniofacial: Special Topics

Background: The contributions of all physician specialties and ancillary services involved in cleft and craniofacial center care must be evaluated to fairly assess the financial impact of a cleft and craniofacial center. The authors hypothesized that the cleft and craniofacial center generates profitable downstream productivity for the academic health system.

Methods: This was a retrospective cohort study of all patients who presented to a cleft and craniofacial center in the first quarter of 2011. Analysis included all health system encounters for each patient over a 2-year period using the electronic medical record and health system financial database.

Results: Sixty-two patients were seen (mean age, 11.4 years; 38 boys and 24 girls; 18 new and 44 established patients). Over 2 years, there were 618 health system encounters (599 outpatient and 19 inpatient encounters), 68 hospital days, and 110 procedures. The most common physician specialty was plastic surgery [312 encounters (50.5 percent)] and the most common ancillary service was speech therapy [256 encounters (41.4 percent)]. The overall reimbursement rate was 39.9 percent, with a majority payor-mix of government payors (62.1 percent). The total profit margin percentage from all encounters was 13.7 percent, which was greater for managed care compared with government payor (38.9 percent versus −10.8 percent; p = 0.022), inpatient compared to outpatient (24.5 percent versus −2.8 percent; p < 0.001), and plastic surgery compared to other specialty encounters (19.7 percent versus 8.7 percent; p = 0.003).

Conclusions: The cleft and craniofacial center generated profitable downstream productivity for the academic health system with referrals to 39 different physician and nonphysician specialties. Health system providers and the business team should align to analyze the center, enhance patient outcomes, and improve specialty care access for patients.

Cleveland, Ohio; and Palo Alto, Calif.

From Case Western Reserve University School of Medicine and the Stanford University Medical Center.

Received for publication April 24, 2016; accepted March 31, 2017.

Presented in part at the 72nd Annual Meeting of the American Cleft Palate–Craniofacial Association, in Palm Springs, California, April 20 through 25, 2015, and winner of Best Clinical Paper, Paul Black Junior Investigator Award; the 94th Annual Meeting of the American Association of Plastic Surgeons, in Scottsdale, Arizona, April 11 through 14, 2015; and the 58th Annual Meeting of the Ohio Valley Society of Plastic Surgeons, in Covington, Kentucky, May 29 through 31, 2015.

Disclosure:The authors have no financial interest or commercial association that might pose or create a conflict of interest with any of the information presented in this article.

Navid Pourtaheri, M.D., Ph.D., Department of Plastic Surgery, University Hospitals Case Medical Center, 11100 Euclid Avenue, 5206 Lakeside Building, Cleveland, Ohio 44106,

Copyright © 2017 by the American Society of Plastic Surgeons