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Calcimimetics and Bundled Reimbursement.

Eugene Lin¹, Suzanne Watnick²

¹Division of Nephrology and Hypertension, Department of Medicine, University of Southern California, Los Angeles, CA; Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA; Kidney Research Center, University of Southern California/University Kidney Research Organization, Los Angeles, CA.

American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation

|January 7, 2019

Summary

Medicare

Keywords:

Etelcalcetide Prospective Payment System (PPS)bone-mineral metabolism bundle calcimimetic dialysis clinic drug costs end-stage renal disease (ESRD)health care incentive hemodialysis medical parathyroidectomy parathyroid hormone (PTH)payment reimbursement rate transition

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Area of Science:

Nephrology
Health Economics

Background:

Medicare's Prospective Payment System bundles dialysis services.
Oral-only medications are currently excluded from the dialysis bundle.
Injectable calcimimetics, like etelcalcetide, are transitioning into the bundle.

Purpose of the Study:

To analyze the implications of incorporating injectable calcimimetics into the Medicare dialysis bundle.
To predict potential impacts on calcimimetic use and patient care.
To highlight the need for careful implementation and monitoring.

Main Methods:

Analysis of Medicare reimbursement policies for renal dialysis.
Review of the transition payment for etelcalcetide.
Assessment of potential provider incentives and financial ramifications.

Main Results:

Injectable calcimimetics will be incorporated into the dialysis bundle after a transition period.
Providers may be incentivized to reduce calcimimetic use post-transition.
The financial impact on dialysis organizations and patient health is uncertain.

Conclusions:

Careful incorporation of calcimimetics into the dialysis bundle is critical.
Close monitoring of patient outcomes is essential to mitigate adverse effects.
Evidence-based guidelines are needed for bone-mineral management in dialysis patients.