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Association of VA Payment Reform for Dialysis with Spending, Access to Care, and Outcomes for Veterans with ESKD.

Publication ,  Journal Article
Wang, V; Swaminathan, S; Corneau, EA; Maciejewski, ML; Trivedi, AN; O'Hare, AM; Mor, V
Published in: Clin J Am Soc Nephrol
November 6, 2020

BACKGROUND AND OBJECTIVES: Because of the limited capacity of its own dialysis facilities, the Department of Veterans Affairs (VA) Veterans Health Administration routinely outsources dialysis care to community providers. Prior to 2011-when the VA implemented a process of standardizing payments and establishing national contracts for community-based dialysis care-payments to community providers were largely unregulated. This study examined the association of changes in the Department of Veterans Affairs payment policy for community dialysis with temporal trends in VA spending and veterans' access to dialysis care and mortality. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: An interrupted time series design and VA, Medicare, and US Renal Data System data were used to identify veterans who received VA-financed dialysis in community-based dialysis facilities before (2006-2008), during (2009-2010), and after the enactment of VA policies to standardize dialysis payments (2011-2016). We used multivariable, differential trend/intercept shift regression models to examine trends in average reimbursement for community-based dialysis, access to quality care (veterans' distance to community dialysis, number of community dialysis providers, and dialysis facility quality indicators), and 1-year mortality over this time period. RESULTS: Before payment reform, the unadjusted average per-treatment reimbursement for non-VA dialysis care varied widely ($47-$1575). After payment reform, there was a 44% reduction ($44-$250) in the adjusted price per dialysis session (P<0.001) and less variation in payments for dialysis ($73-$663). Over the same time period, there was an increase in the number of community dialysis facilities contracting with VA to deliver care to veterans with ESKD from 19 to 37 facilities (per VA hospital), and there were no changes in either the quality of community dialysis facilities or crude 1-year mortality rate of veterans (12% versus 11%). CONCLUSIONS: VA policies to standardize payment and establish national dialysis contracts increased the value of VA-financed community dialysis care by reducing reimbursement without compromising access to care or survival.

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Published In

Clin J Am Soc Nephrol

DOI

EISSN

1555-905X

Publication Date

November 6, 2020

Volume

15

Issue

11

Start / End Page

1631 / 1639

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • United States Department of Veterans Affairs
  • United States
  • Survival Rate
  • Retrospective Studies
  • Renal Dialysis
  • Middle Aged
  • Male
  • Kidney Failure, Chronic
  • Interrupted Time Series Analysis
 

Citation

APA
Chicago
ICMJE
MLA
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Wang, V., Swaminathan, S., Corneau, E. A., Maciejewski, M. L., Trivedi, A. N., O’Hare, A. M., & Mor, V. (2020). Association of VA Payment Reform for Dialysis with Spending, Access to Care, and Outcomes for Veterans with ESKD. Clin J Am Soc Nephrol, 15(11), 1631–1639. https://doi.org/10.2215/CJN.02100220
Wang, Virginia, Shailender Swaminathan, Emily A. Corneau, Matthew L. Maciejewski, Amal N. Trivedi, Ann M. O’Hare, and Vincent Mor. “Association of VA Payment Reform for Dialysis with Spending, Access to Care, and Outcomes for Veterans with ESKD.Clin J Am Soc Nephrol 15, no. 11 (November 6, 2020): 1631–39. https://doi.org/10.2215/CJN.02100220.
Wang V, Swaminathan S, Corneau EA, Maciejewski ML, Trivedi AN, O’Hare AM, et al. Association of VA Payment Reform for Dialysis with Spending, Access to Care, and Outcomes for Veterans with ESKD. Clin J Am Soc Nephrol. 2020 Nov 6;15(11):1631–9.
Wang, Virginia, et al. “Association of VA Payment Reform for Dialysis with Spending, Access to Care, and Outcomes for Veterans with ESKD.Clin J Am Soc Nephrol, vol. 15, no. 11, Nov. 2020, pp. 1631–39. Pubmed, doi:10.2215/CJN.02100220.
Wang V, Swaminathan S, Corneau EA, Maciejewski ML, Trivedi AN, O’Hare AM, Mor V. Association of VA Payment Reform for Dialysis with Spending, Access to Care, and Outcomes for Veterans with ESKD. Clin J Am Soc Nephrol. 2020 Nov 6;15(11):1631–1639.

Published In

Clin J Am Soc Nephrol

DOI

EISSN

1555-905X

Publication Date

November 6, 2020

Volume

15

Issue

11

Start / End Page

1631 / 1639

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • United States Department of Veterans Affairs
  • United States
  • Survival Rate
  • Retrospective Studies
  • Renal Dialysis
  • Middle Aged
  • Male
  • Kidney Failure, Chronic
  • Interrupted Time Series Analysis