Dialysis patients attending independent dialysis facilities with an unfavorable payer mix experienced worse anemia outcomes following expansion of the Medicare end-stage renal disease prospective payment system (PPS) in 2011, according to new study results published in Medical Care.  

Purna Mukhopadhyay, PhD, of Arbor Research Collaborative in Michigan, and collaborators examined changes in anemia outcomes for 122,641 Medicare dialysis patients in 921 independent facilities during 2009 to 2014, which had varying proportions of patients with employer-based group health insurance. Commercial insurances tend to pay much higher rates for dialysis-related services than Medicare. For comparison, the team performed similar analyses of facilities affiliated with large dialysis organizations, which were less affected by the PPS due to economies of scale and an ability to spread risk.

Independent facilities had similar trends in low hemoglobin during 2009 to 2010 before PPS expansion. During 2012 to 2014, however, following expansion, independent facilities with fewer privately insured patients experienced significant increases in the frequency of low hemoglobin. Post-PPS standardized blood transfusion ratios also were 9% higher for these facilities.

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Among large dialysis organizations facilities, however, the investigators found no differences in low hemoglobin by payer mix following PPS.

“Provider responses to payment reform may vary based on attributes such as payer mix that could have implications for health disparities,” Dr Mukhopadhyay and the team stated.

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Mukhopadhyay P, Pearson J, Cogan C, et al. Does one size fit all with the effects of payment reform? Dialysis facility payer mix and anemia management under the expanded Medicare prospective payment system. Med Care. 2019;57:584–591. doi:10.1097/MLR.0000000000001151