Variability in Prices Paid for Hemodialysis by Employer-Sponsored Insurance in the US From 2012 to 2019

League, Riley; Eliason, Paul J.; McDevitt, Ryan C.; Roberts, James W.; Wong, Heather

doi:10.1001/jamanetworkopen.2022.0562

Cited by 8 publications

(8 citation statements)

References 3 publications

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“…Variation in prices paid for health care services is well-documented across geography and payer. [1][2][3][4][5][6] Studies find higher prices among private insurers than Medicare and Medicaid. 3,[6][7][8][9][10] These studies, however, are generally focused on adults, hospital prices, and comparisons between private insurers and Medicare, which rarely covers pediatric services.…”

Section: Introductionmentioning

confidence: 99%

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Variation in prices for an evidence‐based pediatric preventive service

Kranz

Gahlon

Dick

et al. 2022

Health Services Research

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Objective To examine variation in prices paid by private medical insurers for fluoride varnish applications in medical settings, a newly reimbursed service that few children receive. Data Sources Private‐insurance medical claims from Connecticut, Maine, New Hampshire, and Rhode Island (2016–2018). Study Design We examined prices paid for fluoride varnish by private insurers and compared these to prices paid by Medicaid. Data Collection/Extraction Methods Private claims for fluoride varnish during medical visits for children aged 1–5 years. State Medicaid rates for fluoride varnish were obtained from the American Academy of Pediatrics. Principal Findings Prices paid for fluoride varnish by private insurers varied within and across states, ranging from less than $5 to $50. Median prices closely followed Medicaid rates in three of the four states. In states covering a package of fluoride varnish plus additional preventive oral health services during medical visits, combined Medicaid rates were nearly double the median price paid by private insurers. Conclusions Fluoride varnish is a recommended service, but few children receive it. Price variation may contribute to the low uptake of this service. Ensuring sufficient Medicaid and private insurance rates could increase fluoride varnish applications in medical settings and improve oral health.

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Section: Introductionmentioning

confidence: 99%

“…Variation in prices paid for health care services is well‐documented across geography and payer 1–6 . Studies find higher prices among private insurers than Medicare and Medicaid 3,6–10 .…”

Section: Introductionmentioning

confidence: 99%

Variation in prices for an evidence‐based pediatric preventive service

Kranz

Gahlon

Dick

et al. 2022

Health Services Research

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“…15 The differences in spending between enrollees receiving dialysis with private insurance and those with Medicare are especially important given growing concerns about the market power of large dialysis organizations and recent policy proposals. For instance, League et al 8 reported that median prices per hemodialysis session for employer-sponsored plans were 6 times higher than Medicare prices, with the market power of large dialysis organizations one possible explanation for such high rates; the dialysis industry is highly concentrated, with DaVita Inc and Fresenius Medical Care combining to control a 72% share of the market. 16 Because many insurers have limited choice for providing dialysis benefits to their enrollees, large dialysis organizations may be able to command high prices.…”

Section: Discussionmentioning

confidence: 99%

“…To assess how health care spending changes after the start of dialysis, we compared monthly spending for patients before and after their first dialysis treatment with a multivariate regression model using Stata, version 17 (StataCorp LLC). Unlike previous studies that compared patients with kidney failure with different patients who did not receive dialysis care, 4 , 8 our longitudinal data allowed us to follow up patients receiving dialysis. In this way, we were able to control for unobserved, time-invariant differences in health across patients that may be associated with the onset of kidney failure, such as smoking, diet, or exercise habits.…”

Section: Methodsmentioning

confidence: 99%

“…1 , 2 Previous research has reported that the median price paid by employer-sponsored plans for a single hemodialysis session is more than 6 times the base rate paid by Medicare for the same service. 8 This price difference may not be representative of other health care services rendered to privately insured patients receiving dialysis, however, so overall health care spending on these patients remains inconclusive. Furthermore, private insurers may differ from Medicare in their ability to manage nondialysis services, potentially leading to differences in overall spending.…”

Section: Introductionmentioning

confidence: 99%

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Assessment of Spending for Patients Initiating Dialysis Care

et al. 2022

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ImportanceDespite a widespread belief that private insurers spend large amounts on health care for enrollees receiving dialysis, data limitations over the past decade have precluded a comprehensive analysis of the topic.ObjectiveTo examine the amount and types of increases in health care spending for privately insured patients associated with initiating dialysis care.Design, Setting, and ParticipantsA cohort study covering calendar years 2012 to 2019 included patients with kidney failure who had employer-sponsored insurance for 12 months following dialysis initiation. Data analysis was performed from August 27, 2021, to August 18, 2022. The data cover the entirety of the US and were obtained from the Health Care Cost Institute. The data include all medical claims for enrollees in employer-sponsored health insurance plans offered by multiple major health care insurers within the US. Participants included patients younger than 65 years who were continuously enrolled in these plans in the 12 months before and after their first claim for dialysis care. Patients also had to have nonmissing documented key characteristics, such as sex, race and ethnicity, and health characteristics.ExposuresA claim for dialysis care.Main Outcomes and MeasuresOut-of-pocket, inpatient, outpatient, physician services, prescription medication, and total health care spending. The hypothesis tested was formulated before data collection.ResultsThe sample included 309 800 enrollee-months, which was a balanced panel of 25 months for 12 392 enrollees. At baseline, 7534 patients (61%) were male, 5415 (44%) were aged 55 to 64 years, and patients had been enrolled with their insurer for a mean of 30 months (95% CI, 29.9-30.1 months). In the 12 months before initiating dialysis care, total monthly health care spending was $5025 per patient per month (95% CI, $4945-$5106). Dialysis care initiation was associated with an increase in total monthly spending of $14 685 (95% CI, $14 413-$14 957). This increase occurred across all spending categories (dialysis, nondialysis outpatient, inpatient, physician services, and prescription drugs). Monthly patient out-of-pocket spending increased by $170 (95% CI, $162-$178). These spending increases occurred abruptly, beginning about 2 months before dialysis initiation, and remained increased for the subsequent 12 months.Conclusions and RelevanceIn this cohort study, evidence that private insurers experience significant, sustained increases in spending when patients initiated dialysis was noted. The findings suggest that proposed policies aimed at limiting the amount dialysis facilities charge private insurers and the enrollees has the potential to reduce health care spending in this high-cost population.

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