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What can we learn from the U.S. expanded end-stage renal disease bundle?
James D Chambers1, Daniel E Weiner, Sarah K Bliss
1The Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA 02111, USA. jchambers@tuftsmedicalcenter.org
Health Policy (Amsterdam, Netherlands)
|February 20, 2013
Summary
Bundled payments in U.S. healthcare reform, like the expanded End Stage Renal Disease (ESRD) bundle, share financial risk. This payment model impacts dialysis care, potentially increasing home dialysis use and provider consolidation.
Area of Science:
- Health economics
- Healthcare policy
- Nephrology
Background:
- Bundled payment is a key U.S. healthcare reform strategy.
- It encourages cost-effective care by sharing financial risk between payers and providers.
- The expanded End Stage Renal Disease (ESRD) Prospective Payment System is a significant example.
Purpose of the Study:
- To analyze the expanded ESRD bundle 2 years post-implementation.
- To identify emerging lessons and consequences of bundled payment policies.
- To explore research opportunities arising from bundled payments.
Main Methods:
- Qualitative analysis of implementation effects.
- Examination of changes in dialysis care practices.
- Assessment of market and system-wide impacts.
Main Results:
- Implementation influenced erythropoietin stimulating agent use.
- Increased adoption of home-based peritoneal dialysis observed.
- Potential contribution to dialysis provider market consolidation noted.
Conclusions:
- Bundled payment policies present both opportunities and challenges.
- Success depends on cost containment and quality of care.
- Stakeholder input and staged implementation are crucial for policy success.
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