Bundled-Rate Legislation for Medicare Reimbursement for Dialysis Services

Charytan, Chaim

doi:10.2215/cjn.04820610

Cited by 20 publications

(22 citation statements)

References 49 publications

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“…As a result, there has been considerable interest in how anemia treatment patterns have evolved [13][14][15][16][17] . Nearly all studies on this topic have focused on the hemodialysis (HD) population, which in the United States comprises approximately 93% of patients receiving maintenance dialysis [3] .…”

Section: Trends In Anemia Managementmentioning

confidence: 99%

Trends in Anemia Management Practices in Patients Receiving Hemodialysis and Peritoneal Dialysis: A Retrospective Cohort Analysis

Wetmore¹,

Peng²,

Monda³

et al. 2015

Am J Nephrol

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Background/Aims: Recent changes in clinical practice guidelines and reimbursement policies may have affected the use of anemia-related medications and red blood cell (RBC) transfusions in peritoneal dialysis (PD) and hemodialysis (HD) patients. We sought to compare patterns of erythropoiesis-stimulating agents (ESA) and intravenous (IV) iron use, achieved hemoglobin levels, and RBC transfusion use in PD and HD patients. Methods: In quarterly cohorts of prevalent dialysis patients receiving persistent therapy (>3 months), 2007-2011, with Medicare Parts A and B coverage, we assessed ESA and IV iron use and dose, RBC transfusions, and hemoglobin levels. Quarterly transfusion rates were calculated. Results: Observable PD and HD patients numbered 14,958 and 221,866 in Q1/2007 and 17,842 and 256,942 in Q4/2011. Adjusted ESA use was lower in PD (71.4-80.1%) than in HD (86.9-92.0%) patients, decreasing from 80.1% (Q1/2010) to 71.4% (Q4/2011) in PD patients, and from 92.0 to 86.9% in HD patients. The mean adjusted ESA dose decreased by 67.5% in PD and 58.4% in HD patients. IV iron use tended to increase, peaking at 39.3% for PD (Q3/2011) and 80.5% for HD (Q2/2011) patients. Adjusted mean hemoglobin levels fell from 11.7 to 10.6 mg/dl in PD and from 12.0 to 10.7 mg/dl in HD ESA users; adjusted transfusion rates increased from 2.4 to 3.0 per 100 patient-months in PD and from 2.6 to 3.3 in HD patients. Conclusions: In patients receiving persistent dialysis, dose and frequency of ESA administrations decreased during the period 2007-2011. Mean hemoglobin levels decreased by more than 1 g/dl, while transfusion rates increased by approximately 25%.

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Section: Trends In Anemia Managementmentioning

confidence: 99%

Trends in Anemia Management Practices in Patients Receiving Hemodialysis and Peritoneal Dialysis: A Retrospective Cohort Analysis

Wetmore¹,

Peng²,

Monda³

et al. 2015

Am J Nephrol

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“…Many suggest that race should be included in the bundle because of prior observations that African Americans receive more ESA. 38,39 We attempted a post hoc analysis to determine whether hemoglobinopathy traits could explain racial differences in ESA. Among 504 non-African-American patients with HbAA from the same dialysis centers, this group had similar hemoglobin levels (11.360.7) but differed in other clinical and demographic characteristics (Supplemental Table 1).…”

Section: Discussionmentioning

confidence: 99%

Sickle Trait in African-American Hemodialysis Patients and Higher Erythropoiesis-Stimulating Agent Dose

Derebail¹,

Lacson

Kshirsagar³

et al. 2014

Journal of the American Society of Nephrology

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African Americans require higher doses of erythropoiesis-stimulating agents (ESAs) during dialysis to manage anemia, but the influence of sickle cell trait and other hemoglobinopathy traits on anemia in dialysis patients has not been adequately evaluated. We performed a cross-sectional study of a large cohort of adult African-American hemodialysis patients in the United States to determine the prevalence of hemoglobinopathy traits and quantify their influence on ESA dosing. Laboratory and clinical data were obtained over 6 months in 2011. Among 5319 African-American patients, 542 (10.2%) patients had sickle cell trait, and 129 (2.4%) patients had hemoglobin C trait; no other hemoglobinopathy traits were present. Sickle cell trait was more common in this cohort than the general African-American population (10.2% versus 6.5%-8.7%, respectively, P,0.05). Among 5002 patients (10.3% sickle cell trait and 2.4% hemoglobin C trait) receiving ESAs, demographic and clinical variables were similar across groups, with achieved hemoglobin levels being nearly identical. Patients with hemoglobinopathy traits received higher median doses of ESA than patients with normal hemoglobin (4737.4 versus 4364.1 units/treatment, respectively, P=0.02). In multivariable analyses, hemoglobinopathy traits associated with 13.2% more ESA per treatment (P=0.001). Within subgroups, sickle cell trait patients received 13.2% (P=0.003) higher dose and hemoglobin C trait patients exhibited a similar difference (12.9%, P=0.12). Sensitivity analyses using weight-based dosing definitions and separate logistic regression models showed comparable associations. Our findings suggest that the presence of sickle cell trait and hemoglobin C trait may explain, at least in part, prior observations of greater ESA doses administered to African-American dialysis patients relative to Caucasian patients.

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“…The bundled payment system that was approved in 2008 consisting of a single payment for all services covered in a dialysis treatment, might provide a financial incentive to efficiently manage anemia treatment and ESA prescriptions [18]. In the Netherlands, such a bundled payment system has been applied already.…”

Section: Discussionmentioning

confidence: 99%

Poor Compliance with Guidelines on Anemia Treatment in a Cohort of Chronic Hemodialysis Patients

Weerd

Grooteman²,

Mazairac³

et al. 2012

Blood Purif

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Background/Aims: Guidelines for the management of anemia and iron deficiency in chronic hemodialysis (HD) patients have been developed to standardize therapy and improve clinical outcome. The present study evaluated compliance with anemia guidelines and investigated whether differences between centers were present. Methods: Data on anemia management from patients in the baseline cohort of the CONTRAST study (NCT00205556) were analyzed. 598 chronic HD patients (62% male, age 63.6 ± 14.0 years) from 26 Dutch dialysis centers were included. Results: Mean hemoglobin (Hb) level was 11.9 ± 1.3 g/dl and Hb was ≥11.0 g/dl in 81% of the patients. Compliance with all anemia targets (Hb 11.0–12.0 g/dl, transferrin saturation ratio ≥20%, ferritin 100–500 ng/ml) was reached in 11.6% (95% CI 7.8–17.0) of the patients, with a wide range among centers (4–26%, adjusted for case mix, treatment-related factors and center-specific characteristics). Conclusion: Compliance with anemia targets in stable HD patients was poor and showed a wide variation between treatment facilities.

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Bundled-Rate Legislation for Medicare Reimbursement for Dialysis Services

Cited by 20 publications

References 49 publications

Trends in Anemia Management Practices in Patients Receiving Hemodialysis and Peritoneal Dialysis: A Retrospective Cohort Analysis

Trends in Anemia Management Practices in Patients Receiving Hemodialysis and Peritoneal Dialysis: A Retrospective Cohort Analysis

Sickle Trait in African-American Hemodialysis Patients and Higher Erythropoiesis-Stimulating Agent Dose

Poor Compliance with Guidelines on Anemia Treatment in a Cohort of Chronic Hemodialysis Patients

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