Comparing VA and Private Sector Healthcare Costs for End-stage Renal Disease

Hynes, Denise M.; Stroupe, Kevin T.; Fischer, Michael J.; Reda, Domenic J.; Manning, Willard G.; Browning, Margaret M.; Huo, Zhiping; Saban, Karen L.; Kaufman, James S.

doi:10.1097/mlr.0b013e31822dcf15

Cited by 32 publications

(50 citation statements)

References 13 publications

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“…Using our primary outcome measure, Kidney Disease Quality of Life (KDQOL), we note that typical ESRD patients score about 48.6 points on the KDQOL scale (SD ≈ 11.3). 2,4,29,30 With a goal to raise this figure by 10% to 53.5, which can be clinically meaningful, we calculated power based on a comparison of KDQOL score after 12 months of exposure to the intervention to baseline score (or score at entry for those who entered later). Using SAS macro GEESIZE version 3.1, 26 under a Gaussian GEE model for repeated measures, 77 patients total are required to test this hypothesis with power 0.80 at the alpha = 0.05 two-sided level of significance.…”

Section: Methodsmentioning

confidence: 99%

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Rationale and design of a patient-centered medical home intervention for patients with end-stage renal disease on hemodialysis

Porter¹,

Fitzgibbon²,

Fischer³

et al. 2015

Contemporary Clinical Trials

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In the U.S., more than 400,000 individuals with end-stage renal disease (ESRD) require hemodialysis (HD) for renal replacement therapy. ESRD patients experience a high burden of morbidity, mortality, resource utilization, and poor quality of life (QOL). Under current care models ESRD patients receive fragmented care from multiple providers at multiple locations. The Patient-Centered Medical Home (PCMH) is a team approach, providing coordinated care across the healthcare continuum. While this model has shown some early benefits for complex chronic diseases such as diabetes, it has not been applied to HD patients. This study is a non-randomized quasi-experimental intervention trial implementing a Patient-Centered Medical Home for Kidney Disease (PCMH-KD). The PCMH-KD extends the existing dialysis care team (comprised of a nephrologist, dialysis nurse, dialysis technician, social worker, and dietitian) by adding a general internist, pharmacist, nurse coordinator, and a community health worker, all of whom will see the patients together, and separately, as needed. The primary goal is to implement a comprehensive, multidisciplinary care team to improve care coordination, quality of life, and healthcare use for HD patients. Approximately 240 patients will be recruited from two sites; a non-profit university-affiliated dialysis center and an independent for-profit dialysis center. Outcomes include: i) patient-reported outcomes, including QOL and satisfaction; ii) clinical outcomes, including blood pressure and diet; iii) healthcare use, including emergency room visits and hospitalizations; and iv) staff perceptions. Given the significant burden that patients with ESRD on HD experience, enhanced care coordination provides an opportunity to reduce this burden and improve QOL.

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Section: Methodsmentioning

confidence: 99%

“…1 Despite the relatively low prevalence of ESRD, healthcare expenditures for these patients are disproportionately high, 1, 2 and individuals experience high morbidity, mortality, and poor quality of life (QOL). 1,3,4,5,6 In 2012, Medicare expenditures for ESRD totaled $28.6 billion.…”

Section: Introductionmentioning

confidence: 99%

Rationale and design of a patient-centered medical home intervention for patients with end-stage renal disease on hemodialysis

Porter¹,

Fitzgibbon²,

Fischer³

et al. 2015

Contemporary Clinical Trials

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“…37 Four studies examined equity, with one study showing better performance on several chronic disease and preventive measures, 51 one study showing worse performance in VA facilities for emergency room visits among cancer patients in the last month of life, 76 and two studies showing similar equity in 30-day post-admission mortality 78 and graft failure. 27 Nine articles compared efficiency using utilization, with six studies showing worse performance in VA facilities on outcomes such as average length of stay and service utilization for patients on dialysis, 32,61,[79][80][81][82] two showing better performance for visits/ admissions 83 and generic drug utilization, 84 and one with mixed results for utilization-related inpatient quality indicators. Five studies examined patient-centeredness; three studies demonstrated better patient and family satisfaction in VA facilities 77,85,86 and two demonstrated similar performance in perceptions of racial discrimination and satisfaction in transitional programs for homeless veterans.…”

Section: Safetymentioning

confidence: 99%

Comparing VA and Non-VA Quality of Care: A Systematic Review

et al. 2016

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“…Prior work has examined utilization and outcomes of renal care in VA and Medicare systems [4,6], but less is known about the VA’s own organization of in- and out-of-network chronic dialysis treatment services. VA-outsourced dialysis is a major contributor to increasing ESRD costs for the VA.…”

Section: Introductionmentioning

confidence: 99%

Comparison of outcomes for veterans receiving dialysis care from VA and non-VA providers

Wang

Maciejewski

Patel

et al. 2013

BMC Health Serv Res

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BackgroundDemand for dialysis treatment exceeds its supply within the Veterans Health Administration (VA), requiring VA to outsource dialysis care by purchasing private sector dialysis for veterans on a fee-for-service basis. It is unclear whether outcomes are similar for veterans receiving dialysis from VA versus non-VA providers. We assessed the extent of chronic dialysis treatment utilization and differences in all-cause hospitalizations and mortality between veterans receiving dialysis from VA versus VA-outsourced providers.MethodsWe constructed a retrospective cohort of veterans in 2 VA regions who received chronic dialysis treatment financed by VA between January 2007 and December 2008. From VA administrative data, we identified veterans who received outpatient dialysis in (1) VA, (2) VA-outsourced settings, or (3) both (“dual”) settings. In adjusted analyses, we used two-part and logistic regression to examine associations between dialysis setting and all-cause hospitalization and mortality one-year from veterans’ baseline dialysis date.ResultsOf 1,388 veterans, 27% received dialysis exclusively in VA, 47% in VA-outsourced settings, and 25% in dual settings. Overall, half (48%) were hospitalized and 12% died. In adjusted analysis, veterans in VA-outsourced settings incurred fewer hospitalizations and shorter hospital stays than users of VA due to favorable selection. Dual-system dialysis patients had lower one-year mortality than veterans receiving VA dialysis.ConclusionsVA expenditures for “buying” outsourced dialysis are high and increasing relative to “making” dialysis treatment within its own system. Outcomes comparisons inform future make-or-buy decisions and suggest the need for VA to consider veterans’ access to care, long-term VA savings, and optimal patient outcomes in its placement decisions for dialysis services.

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Comparing VA and Private Sector Healthcare Costs for End-stage Renal Disease

Abstract: Continued research addressing costs and effectiveness of care across public and private sector settings is critical in informing health policy options for patients with complex chronic illnesses such as ESRD.

Cited by 32 publications

References 13 publications

Rationale and design of a patient-centered medical home intervention for patients with end-stage renal disease on hemodialysis

Rationale and design of a patient-centered medical home intervention for patients with end-stage renal disease on hemodialysis

Comparing VA and Non-VA Quality of Care: A Systematic Review

Comparison of outcomes for veterans receiving dialysis care from VA and non-VA providers

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