Price of Dialysis, Unit Staffing, and Length of Dialysis Treatments

Held, Philip J.; Garcia, Jose R.; Pauly, Mark V.; Cahn, Marjorie A.

doi:10.1016/s0272-6386(12)70362-1

Cited by 57 publications

(30 citation statements)

References 2 publications

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“…Renal Data System. 2007), receipt of renal transplants (Garg et al 1999), and staffing by chain status (Held et al 1990; Ozgen 2006). Therefore a question remains whether these differences in chain practice patterns could lead to a difference in patient outcomes.…”

Section: Introductionmentioning

confidence: 99%

The Effect of Dialysis Chains on Mortality among Patients Receiving Hemodialysis

Zhang

Cotter

Thamer

2010

Health Services Research

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Objective To examine the association between dialysis facility chain-affiliation and patient mortality. Study Setting Medicare dialysis population. Study Design Data from the US Renal Data System (USRDS) were used to identify 3,601 freestanding dialysis facilities and 34,914 Medicare patients incident to end-stage renal disease (ESRD) in 2004. Mixed-effect regression models were used to estimate patient mortality by dialysis facility chain and profit status during the 2-year follow-up. Data Collection USRDS data were matched with facility, cost, and census data. Principle Findings Of the five largest dialysis chains, the lowest mortality risk was observed among patients dialyzed at nonprofit Chain 5 facilities. Compared to Chain 5, hazard ratios were 19% higher (95% CI 1.06 to 1.34) and 24% higher (95% CI 1.10 to 1.40) for patients dialyzed at for-profit Chain 1 and Chain 2 facilities, respectively. In addition, patients at for-profit facilities had a 13% higher risk of mortality than those in nonprofit facilities (95% CI 1.06 to 1.22). Conclusions Large chain affiliation is an independent risk factor for ESRD mortality in the US. Given the movement towards further consolidation of large for-profit chains, reasons behind the increase in mortality require scrutiny.

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Section: Introductionmentioning

confidence: 99%

The Effect of Dialysis Chains on Mortality among Patients Receiving Hemodialysis

Zhang

Cotter

Thamer

2010

Health Services Research

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“…Considering the tremendous growth in the number of facilities, in particular for-profit ones -and their continued profitability despite the apparent fiscal pressure exerted by the federal government -the profile of the market makes clear how lucrative the dialysis industry can be [4,6,9,13,14]. The market profile also is consistent with research demonstrating that dialysis facilities are employing these strategies to cut costs and thus increase profits: (1) changing their technology (e.g., reprocessing and reusing dialyzers) [4,7,14], (2) changing medical practice (e.g., prescribing smaller doses of erythropoietin, EPO, which is used to correct anemia associated with chronic renal failure and ESRD) [15], (3) changing staffing patterns (e.g., reducing the number of registered nurses) [7,16], and (4) entering affiliations with multi-facility chain organizations [9]. To the extent that facilities undertake such measures, they may reduce their production costs and in turn increase profits.…”

Section: Introductionmentioning

confidence: 99%

Longitudinal Analysis of Efficiency in Multiple Output Dialysis Markets

Özgen

Özcan

2004

Health Care Manage Sci

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Provider efficiency in the dialysis industry in the U.S.A. has been of great interest for a variety of parties mainly because of the continuing growth in the number of such patients and providers and in the industry's costs. This study examined technical efficiency longitudinally among the multiple-output producers of freestanding facilities, as the dominant group of providers, using the DEA-based Malmquist index. Nationally representative data were obtained from Independent Renal Facility Cost Report Data Files for the years 1994 through 2000. The resulting sample comprised 140 facilities that had operated throughout the seven study years and jointly produced all dialysis outputs with nonzero inputs. The results show that over the period 1994-2000, on average multi-output, freestanding dialysis facilities did not achieve improvement in productivity. Decomposition of the Malmquist productivity indices showed improvement in technical efficiency but at the same time regress in technologies with potential to improve their quality of care. Negative change in technology was the major source of negative movement in productivity. The study concludes that under the fixed-price payment policy, multiple dialysis outputs are produced efficiently, but it may be that the quality of care is being sacrificed.

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“…[6][7][8][9] Compared with chain-affiliated units, those that are independently owned and/or hospital-based have a greater proportion of patients receiving peritoneal dialysis, more patients receiving transplants, lower ratios of patients to staff, and higher average costs per dialysis session. 10 A study of epoetin treatment conducted in 1990, when Medicare reimbursement policy capitated payment for epoetin and smaller doses resulted in greater profit margins, found that forprofit facilities administered smaller doses of epoetin compared with nonprofit facilities. 11 Since 1991, epoetin payment has been based on the amount of drug administered, creating a financial incentive for increased use of this therapy.…”

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confidence: 99%