Initially we took per dialysis hour measurements for water and electricity in the workshop and extrapolated to all patients. There were inaccuracies for very long or very short treatments, but it was a start.
After complaints from some patients saying we were significantly under paying, we fitted meters to all new installs and used those figures to better estimate the older un-metered patients. There were still errors (e.g. 300ml vs 700ml flow), but it was ball park accurate for 'typical' setups.
For reference our figures were in the region of 0.22m3 water and 2.92KWhr electricity per dialysis hour (including softener regens, RO heat san cycles etc, etc). The patients then got that figure times what their per-unit utility charges were.
Still we got complaints.
We ended up retrofitting electricity and water meters to all installations (the latter to non water-rate patients only) to remove all doubt. Nobody can complain now, they get what they've used. Though in some cases it's less than they got when we were estimating...
Not fielding the complains is a lot less hassle for us. We keep a chart of usage so we can spot any anomalies -like they're plugging a 3 bar electric fire into the dialysis socket
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