Home Dialysis Use Declines in Wake of Payment Reform
Medicare patients affected by the reform experienced a 12% decrease in home dialysis use compared those unaffected by the reform.
SAN DIEGO—Home dialysis use declined in the United States following implementation of federal physician payment reform for in-center hemodialysis (HD), researchers reported at Kidney Week.
In 2004, the Centers for Medicare and Medicaid Services changed physician payment for in-center HD from a capitated to a tiered fee-for-service model, boosting physician reimbursement for frequent in-center dialysis visits, investigators Kevin F. Erickson, MD, of Stanford University in Palo Alto, Calif., and colleagues noted. The researchers evaluated the influence of this change using a national cohort of patients initiating dialysis in the 3 years before and after payment reform.
Patients with traditional Medicare coverage (who were affected by the reform) experienced a 12% decrease in the odds of home dialysis use following payment reform compared with patients with Medicare Advantage (who were not affected by the reform), according to the investigators. Patients living in areas with larger dialysis facilities—where payment reform made in-center HD comparatively more lucrative for physicians—experienced a 16% decrease in the odds of home dialysis use following payment reform compared with patients living in areas with smaller facilities—where payment reform made in-center HD comparatively less lucrative for physicians, Dr. Erickson's group reported.
“National physician payment reform intended to improve the quality of dialysis care resulted in fewer patients receiving home dialysis,” the authors concluded in their study abstract. “This highlights a major failure of the policy and the importance of considering unintended consequences of future physician payment reform efforts.”