New technology and economic incentives will spur the growth of dialysis at home

Prospective reimbursement was HCFA's attempt to rein in the spiralling cost of the ESRD program. Its implementation would press far-ranging changes upon the operations of providers. As a supplier to the dialysis community. Travenol would also have to adapt if the implications desired by HCFA were likely to come to pass. It was crucial to our planning to assess and understand the implications of the new regulations. We examined two key assumptions in HCFA's design: whether home care was a feasible alternative to in-center care, and whether the costs at home were lower than in-center. CAPD, a relatively new home dialysis procedure, would be the likely target to absorb the bulk of the potential shift in patient referrals. Not an option for everyone, CAPD was limited by medical contraindications (e.g. diverticulitis) and by the requirements of self care. Yet the number of patients on CAPD had grown dramatically from its development in the late 1970s. Worldwide, the number of patients had grown to over 20,000. Despite its apparent success, many nephrologists remained skeptical that CAPD offered care comparable to in-center hemodialysis. Upon examination, it appeared that this controversy was fading as more and more evidence came to light suggesting equivalency. A shift in referral patterns looked feasible. To spur the shift, HCFA attempted to design economic incentives into the reimbursement system. The incentives relied on the costs of home dialysis being lower than those in-center--a fact thrown into question when HCFA's cost database was deemed of doubtful accuracy.(ABSTRACT TRUNCATED AT 250 WORDS)