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Medicare's New Prospective Payment System on Facility Provision of Peritoneal Dialysis.

Publication ,  Journal Article
Wang, V; Coffman, CJ; Sanders, LL; Lee, S-YD; Hirth, RA; Maciejewski, ML
Published in: Clin J Am Soc Nephrol
December 7, 2018

BACKGROUND AND OBJECTIVES: Peritoneal dialysis is a self-administered, home-based treatment for ESKD associated with equivalent mortality, higher quality of life, and lower costs compared with hemodialysis. In 2011, Medicare implemented a comprehensive prospective payment system that makes a single payment for all dialysis, medication, and ancillary services. We examined whether the prospective payment system increased dialysis facility provision of peritoneal dialysis services and whether changes in peritoneal dialysis provision were more common among dialysis facilities that are chain affiliated, located in nonurban areas, and in regions with high dialysis market competition. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We conducted a longitudinal retrospective cohort study of n=6433 United States nonfederal dialysis facilities before (2006-2010) and after (2011-2013) the prospective payment system using data from the US Renal Data System, Medicare, and Area Health Resource Files. The outcomes of interest were a dichotomous indicator of peritoneal dialysis service availability and a discrete count variable of dialysis facility peritoneal dialysis program size defined as the annual number of patients on peritoneal dialysis in a facility. We used general estimating equation models to examine changes in peritoneal dialysis service offerings and peritoneal dialysis program size by a pre- versus post-prospective payment system effect and whether changes differed by chain affiliation, urban location, facility size, or market competition, adjusting for 1-year lagged facility-, patient with ESKD-, and region-level demographic characteristics. RESULTS: We found a modest increase in observed facility provision of peritoneal dialysis and peritoneal dialysis program size after the prospective payment system (36% and 5.7 patients in 2006 to 42% and 6.9 patients in 2013, respectively). There was a positive association of the prospective payment system with peritoneal dialysis provision (odds ratio, 1.20; 95% confidence interval, 1.13 to 1.18) and PD program size (incidence rate ratio, 1.27; 95% confidence interval, 1.22 to 1.33). Post-prospective payment system change in peritoneal dialysis provision was greater among nonurban (P<0.001), chain-affiliated (P=0.002), and larger-sized facilities (P<0.001), and there were higher rates of peritoneal dialysis program size growth in nonurban facilities (P<0.001). CONCLUSIONS: Medicare's 2011 prospective payment system was associated with more facilities' availability of peritoneal dialysis and modest growth in facility peritoneal dialysis program size. PODCAST: This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2018_11_19_CJASNPodcast_18_12_.mp3.

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Published In

Clin J Am Soc Nephrol

DOI

EISSN

1555-905X

Publication Date

December 7, 2018

Volume

13

Issue

12

Start / End Page

1833 / 1841

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • United States
  • Retrospective Studies
  • Prospective Payment System
  • Peritoneal Dialysis
  • Middle Aged
  • Medicare
  • Longitudinal Studies
  • Kidney Failure, Chronic
  • Humans
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Wang, V., Coffman, C. J., Sanders, L. L., Lee, S.-Y., Hirth, R. A., & Maciejewski, M. L. (2018). Medicare's New Prospective Payment System on Facility Provision of Peritoneal Dialysis. Clin J Am Soc Nephrol, 13(12), 1833–1841. https://doi.org/10.2215/CJN.05680518
Wang, Virginia, Cynthia J. Coffman, Linda L. Sanders, Shoou-Yih D. Lee, Richard A. Hirth, and Matthew L. Maciejewski. “Medicare's New Prospective Payment System on Facility Provision of Peritoneal Dialysis.Clin J Am Soc Nephrol 13, no. 12 (December 7, 2018): 1833–41. https://doi.org/10.2215/CJN.05680518.
Wang V, Coffman CJ, Sanders LL, Lee S-YD, Hirth RA, Maciejewski ML. Medicare's New Prospective Payment System on Facility Provision of Peritoneal Dialysis. Clin J Am Soc Nephrol. 2018 Dec 7;13(12):1833–41.
Wang, Virginia, et al. “Medicare's New Prospective Payment System on Facility Provision of Peritoneal Dialysis.Clin J Am Soc Nephrol, vol. 13, no. 12, Dec. 2018, pp. 1833–41. Pubmed, doi:10.2215/CJN.05680518.
Wang V, Coffman CJ, Sanders LL, Lee S-YD, Hirth RA, Maciejewski ML. Medicare's New Prospective Payment System on Facility Provision of Peritoneal Dialysis. Clin J Am Soc Nephrol. 2018 Dec 7;13(12):1833–1841.

Published In

Clin J Am Soc Nephrol

DOI

EISSN

1555-905X

Publication Date

December 7, 2018

Volume

13

Issue

12

Start / End Page

1833 / 1841

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • United States
  • Retrospective Studies
  • Prospective Payment System
  • Peritoneal Dialysis
  • Middle Aged
  • Medicare
  • Longitudinal Studies
  • Kidney Failure, Chronic
  • Humans