Home Dialysis in the Prospective Payment System Era

Area of Science:

• Nephrology
• Health Services Research
• Health Economics

Background:

• The End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) aimed to enhance home dialysis utilization through financial incentives.
• Key incentives included bundled payments for injectable medications and dedicated payments for home dialysis training.

Purpose of the Study:

• To evaluate the impact of the ESRD PPS on home dialysis use among incident dialysis patients in the United States.
• To compare the effects of the ESRD PPS on home dialysis use between Medicare beneficiaries and patients with other insurance types.

Main Methods:

• Analysis of data from the United States Renal Data System (USRDS) for patients initiating dialysis between January 2006 and August 2013.
• Multivariable logistic regression was employed to estimate the association between the ESRD PPS and home dialysis use.
• Subgroup analyses compared the policy's effect on Medicare beneficiaries versus patients with non-Medicare insurance.

Main Results:

• The ESRD PPS was associated with a 5.0% overall increase in home dialysis use.
• Home dialysis use increased by 5.8% for Medicare beneficiaries and 4.1% for patients with other insurance, with no statistically significant difference between groups.
• The training add-on payment did not show an independent association with increased home dialysis use beyond the overall policy effect.

Conclusions:

• The bundling of injectable medications within the ESRD PPS was the primary driver of increased home dialysis utilization.
• The positive effects of the ESRD PPS on home dialysis were consistent across both Medicare and non-Medicare patient populations.
• Significant Medicare payment reforms can have broad spill-over effects, influencing the care of all patients with ESRD, irrespective of their insurance.