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Trends in Dialysis Industry Consolidation After Medicare Payment Reform, 2006-2016.

Publication ,  Journal Article
Sloan, CE; Hoffman, A; Maciejewski, ML; Coffman, CJ; Trogdon, JG; Wang, V
Published in: JAMA Health Forum
November 2021

IMPORTANCE: The dialysis industry is highly concentrated, with large dialysis organizations now providing dialysis for more than 85% of patients with kidney failure in the United States. In 2011, Medicare introduced a new Prospective Payment System (PPS) for end-stage kidney disease, which bundled payment for dialysis care into 1 payment per patient. Trends in dialysis facility consolidation after the PPS went into effect are unknown. OBJECTIVE: To determine whether the introduction of the PPS in 2011 was associated with an acceleration in acquisitions and closures of small dialysis chains (<20 facilities) and independently owned facilities. DESIGN SETTING AND PARTICIPANTS: This retrospective cohort study included all Medicare-certified independent or small chain-affiliated dialysis facilities in the continental US between 2006 and 2016. Data were obtained from Medicare and the US Renal Data System and were analyzed in 2020. EXPOSURES: The PPS. MAIN OUTCOMES AND MEASURES: Discrete time hazard models were used to estimate the odds of acquisition and closure before the PPS (2006-2010) vs after the PPS (2011-2016). Analyses controlled for facility, market, and regional demographic characteristics. The average predicted marginal probabilities of acquisition and closure over time were estimated. RESULTS: The proportion of small chain-affiliated and independently owned facilities declined from 29% (1383 of 4750 facilities) in 2006 to 15% (1038 of 6738) in 2016. Among 13 481 facility-years, 6352 (47%) were for profit, and mean (SD) census was 68 (59) patients. Overall, 3286 (24%) facilities opened during the observation period. The proportion of acquisitions that occurred each year varied from 1.1% (12 of 1065 facilities in 2015) to 7.2% (86 of 1192 facilities in 2012), while closures varied from 0.8% (9 of 1065 facilities in 2015) to 2.2% (28 of 1286 facilities in 2010), making both fairly rare. There was a 3.48 higher odds of acquisition in the post-PPS period compared with the pre-PPS period (95% CI, 1.62-7.47; P = .001). The odds of closure before and after the PPS were not statistically significantly different (odds ratio, 2.03; 95% CI, 0.61-6.73; P = .25). Facilities that opened during the observation period had a 7.2% higher predicted probability of acquisition compared with older facilities (95% CI, 5.4%-9.0%; P < .001). CONCLUSIONS AND RELEVANCE: In this cohort study of continental US Medicare-certified dialysis facilities, small-chain and independently owned facilities retained a declining share of the dialysis market. Further research should evaluate the effect of continued dialysis market consolidation on patient access, health care utilization, and clinical outcomes.

Duke Scholars

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Published In

JAMA Health Forum

DOI

EISSN

2689-0186

Publication Date

November 2021

Volume

2

Issue

11

Start / End Page

e213626

Location

United States

Related Subject Headings

  • United States
  • Retrospective Studies
  • Renal Dialysis
  • Prospective Payment System
  • Medicare
  • Humans
  • Cohort Studies
  • Aged
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Sloan, C. E., Hoffman, A., Maciejewski, M. L., Coffman, C. J., Trogdon, J. G., & Wang, V. (2021). Trends in Dialysis Industry Consolidation After Medicare Payment Reform, 2006-2016. JAMA Health Forum, 2(11), e213626. https://doi.org/10.1001/jamahealthforum.2021.3626
Sloan, Caroline E., Abby Hoffman, Matthew L. Maciejewski, Cynthia J. Coffman, Justin G. Trogdon, and Virginia Wang. “Trends in Dialysis Industry Consolidation After Medicare Payment Reform, 2006-2016.JAMA Health Forum 2, no. 11 (November 2021): e213626. https://doi.org/10.1001/jamahealthforum.2021.3626.
Sloan CE, Hoffman A, Maciejewski ML, Coffman CJ, Trogdon JG, Wang V. Trends in Dialysis Industry Consolidation After Medicare Payment Reform, 2006-2016. JAMA Health Forum. 2021 Nov;2(11):e213626.
Sloan, Caroline E., et al. “Trends in Dialysis Industry Consolidation After Medicare Payment Reform, 2006-2016.JAMA Health Forum, vol. 2, no. 11, Nov. 2021, p. e213626. Pubmed, doi:10.1001/jamahealthforum.2021.3626.
Sloan CE, Hoffman A, Maciejewski ML, Coffman CJ, Trogdon JG, Wang V. Trends in Dialysis Industry Consolidation After Medicare Payment Reform, 2006-2016. JAMA Health Forum. 2021 Nov;2(11):e213626.

Published In

JAMA Health Forum

DOI

EISSN

2689-0186

Publication Date

November 2021

Volume

2

Issue

11

Start / End Page

e213626

Location

United States

Related Subject Headings

  • United States
  • Retrospective Studies
  • Renal Dialysis
  • Prospective Payment System
  • Medicare
  • Humans
  • Cohort Studies
  • Aged