Impact of the bundled end-stage renal disease payment system on patient care

This article provides a perspective on the impact of the bundled end-stage renal disease prospective payment system on patient care. As the first year of the bundle comes to a close, we are beginning to see information about practice pattern changes that have resulted and the impact of those changes on the care of patients with renal disease. This review recognizes the background of the prospective payment system for renal replacement therapy and its evolution to include multiple components, as well as a description of the features of this payment system that are expected to have an impact on the clinical care by nephrologists and dialysis providers. Some of the expected impact on the dosing of erythropoiesis-stimulating agents, consolidation of dialysis providers, and a move toward more measurement are beginning to be seen. This brief summary not only reviews the components of the bundled payment system, but also the anticipated impact and some early information on the response to these predicted findings in the industry.