|The following article features coverage from the National Kidney Foundation’s virtual 2020 Spring Clinical Meetings. Click here to read more of Renal and Urology News’ conference coverage.|
Use of thrombolytic agents declined in hemodialysis (HD) units and rose outside of HD units following implementation of the federal prospective payment system (PPS) for dialysis services in 2011, investigators reported at the live virtual 2020 National Kidney Foundation Spring Clinical Meetings.
Mechanical clot removal increased and catheter replacement declined following PPS implementation.
Under the PPS, dialysis providers receive a single comprehensive payment for the medical care (“bundling”). The payment also covers the use of injectable drugs, which providers were able to bill for separately prior to bundling.
A team led by James B. Wetmore, MD, of the Hennepin County Medical Center in Minneapolis, Minnesota, used data from the US Renal Data System to analyze 31 quarterly cohorts of HD patients who used a catheter for vascular access during each year from 2008 to 2015. On average, each quarter had 69,428 patients. Study outcomes were claims for thrombolytic use, mechanical clot removal, and catheter replacement identified using HCPCS/ICD-9 codes.
During the pre-PPS period (2008-2010), within-HD-unit thrombolytic claims decreased by 2.6% per quarter; post-PPS, claims decreased by 11% per quarter, A, reported in a poster presentation. Outside-HD-unit thrombolytic claims increased by 0.5% per quarter pre-PPS implementation compared with a 1.1% increase per quarter post-PPS.
Mechanical clot removal claims increased by 1.9% per quarter pre-PPS compared with a 3.8% rise per quarter post-PPS. Catheter replacement claims rose by 0.1% per quarter pre-PPS and decreased by 0.8% per quarter post-PPS.
Moreover, before and after PPS implementation, Dr Wetmore’s team found that thrombolytic use outside of HD units, compared with inside, was significantly associated with 30% and 21% increased odds of missed or delayed HD sessions, respectively. During the pre-PPS period, thrombolytic use outside of HD units, compared with inside, was significantly associated with a 17% increased odds of catheter replacement. In the post-PPS period, the location of thrombolytic administration had no significant effect on the odds of catheterization.
“It remains unclear whether these associations are explained by delays in care result from referral outside the HD unit vs confounding by thrombosis severity,” the authors noted.
Read more of our coverage of the National Kidney Foundation’s virtual 2020 Spring Clinical Meetings by visiting the conference page.
Wetmore JB, Guo H, Decker-Palmer M, et al. Impact of the CMS payment bundle for hemodialysis vascular access. Data presented at the live virtual 2020 National Kidney Foundation Spring Clinical Meetings held March 25 to 29. ePoster 309.