Cost, work, reimbursement, and the pediatric nephrologist in the United States Medicare/End-Stage Renal Disease...

Area of Science:

• Nephrology
• Pediatrics
• Healthcare Economics

Background:

• Children with end-stage renal disease (ESRD) require specialized care.
• Existing payment models may not adequately reflect the intensity of pediatric ESRD care.

Purpose of the Study:

• To survey the work involved in providing care to pediatric patients with ESRD.
• To justify higher Medicare reimbursement for pediatric dialysis care.

Main Methods:

• A collaborative survey was conducted by the American Academy of Pediatrics, American Society of Pediatric Nephrology, and Renal Physicians Association.
• Data were presented to the AMA Specialty Society Relative Value Scale Update Committee (RUC).
• Age-based monthly capitation payment Current Procedural Terminology codes were utilized.

Main Results:

• Pediatric dialysis care is more time-consuming and intense than adult care.
• Recommended Relative Work Units by the RUC for Medicare: infants (0-2 years) 13.25, children (2-12 years) 9.13, adolescents (12-19 years) 6.47, adults (>19 years) 5.24.

Conclusions:

• The intensity of pediatric end-stage renal disease care warrants higher payment rates.
• A framework for describing services for pediatric dialysis patients under monthly capitation was developed.