Variations in Payment for Dialysis—Implications for Policy and Practice

Abstract

The article by League and colleagues 1 notes that, in their study, spending for patients with employersponsored health insurance increased by more than $14 000 per month in the year following the initiation of dialysis, and the level of spending more than doubled Medicare fee-for-service (FFS) spending for the care of patients receiving dialysis. Although spending for all major categories of care increased with initiation of dialysis, spending for the dialysis treatments themselves, which averaged about $10 000 per month, dominated the increase.These results for the employer-sponsored insurance market provide a crucial piece of the dialysis spending puzzle. The same authors also found that the median price paid per dialysis session by employer-sponsored insurers was more than 6 times as high as that paid by Medicare FFS. 2 Trish and colleagues 3 recently provided another piece of the puzzle by demonstrating similar spending associated with dialysis in the individual insurance market. Medicare FFS spending includes most

Social Risk and Dialysis Facility Performance in the First Year of the ESRD Treatment Choices Model

“…Furthermore, non-Hispanic Black, uninsured, Medicaid-covered, and socioeconomically disadvantaged patients are highly concentrated within dialysis facilities that have lower use of home dialysis and receipt of transplants. Although the financial margins on Medicare dialysis payments are highly variable (approximately <0.5% on average), facilities that serve high proportions of patients who are uninsured or are covered by Medicaid likely operate on particularly narrow margins. The magnitude of the ETC model’s 5% to 10% penalty on all Medicare reimbursements, larger than previous quality kidney failure programs, may threaten the solvency of these safety-net centers.…”