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Clinical Epidemiology
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Home Dialysis in the Prospective Payment System Era

Eugene Lin, Xingxing S. Cheng, Kuo-Kai Chin, Talhah Zubair, Glenn M. Chertow, Eran Bendavid and Jayanta Bhattacharya
JASN October 2017, 28 (10) 2993-3004; DOI: https://doi.org/10.1681/ASN.2017010041
Eugene Lin
*Department of Medicine, Division of Nephrology, and
†Center for Health Policy and Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, California
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Xingxing S. Cheng
*Department of Medicine, Division of Nephrology, and
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Kuo-Kai Chin
‡Stanford University School of Medicine, Stanford, California; and
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Talhah Zubair
‡Stanford University School of Medicine, Stanford, California; and
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Glenn M. Chertow
*Department of Medicine, Division of Nephrology, and
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Eran Bendavid
†Center for Health Policy and Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, California
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Jayanta Bhattacharya
†Center for Health Policy and Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, California
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Abstract

The ESRD Prospective Payment System introduced two incentives to increase home dialysis use: bundling injectable medications into a single payment for treatment and paying for home dialysis training. We evaluated the effects of the ESRD Prospective Payment System on home dialysis use by patients starting dialysis in the United States from January 1, 2006 to August 31, 2013. We analyzed data on dialysis modality, insurance type, and comorbidities from the United States Renal Data System. We estimated the effect of the policy on home dialysis use with multivariable logistic regression and compared the effect on Medicare Parts A/B beneficiaries with the effect on patients with other types of insurance. The ESRD Prospective Payment System associated with a 5.0% (95% confidence interval [95% CI], 4.0% to 6.0%) increase in home dialysis use by the end of the study period. Home dialysis use increased by 5.8% (95% CI, 4.3% to 6.9%) among Medicare beneficiaries and 4.1% (95% CI, 2.3% to 5.4%) among patients covered by other forms of health insurance. The difference between these groups was not statistically significant (1.8%; 95% CI, −0.2% to 3.8%). Conversely, in both populations, the training add-on did not associate with increases in home dialysis use beyond the effect of the policy. The ESRD Prospective Payment System bundling, but not the training add-on, associated with substantial increases in home dialysis, which were identical for both Medicare and non-Medicare patients. These spill-over effects suggest that major payment changes in Medicare can affect all patients with ESRD.

  • chronic dialysis
  • Economic Analysis
  • end-stage renal disease
  • peritoneal dialysis
  • United States Renal Data System
  • Copyright © 2017 by the American Society of Nephrology
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Journal of the American Society of Nephrology: 28 (10)
Journal of the American Society of Nephrology
Vol. 28, Issue 10
October 2017
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Home Dialysis in the Prospective Payment System Era
Eugene Lin, Xingxing S. Cheng, Kuo-Kai Chin, Talhah Zubair, Glenn M. Chertow, Eran Bendavid, Jayanta Bhattacharya
JASN Oct 2017, 28 (10) 2993-3004; DOI: 10.1681/ASN.2017010041

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Home Dialysis in the Prospective Payment System Era
Eugene Lin, Xingxing S. Cheng, Kuo-Kai Chin, Talhah Zubair, Glenn M. Chertow, Eran Bendavid, Jayanta Bhattacharya
JASN Oct 2017, 28 (10) 2993-3004; DOI: 10.1681/ASN.2017010041
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More in this TOC Section

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  • Association of Clonal Hematopoiesis of Indeterminate Potential with Worse Kidney Function and Anemia in Two Cohorts of Patients with Advanced Chronic Kidney Disease
  • Longitudinal TNFR1 and TNFR2 and Kidney Outcomes: Results from AASK and VA NEPHRON-D
Show more Clinical Epidemiology

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  • Trends in Peritoneal Dialysis Use in the United States after Medicare Payment Reform
  • Expanded Prospective Payment System and Use of and Outcomes with Home Dialysis by Race and Ethnicity in the United States
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  • A View of the Bundle from a Home Dialysis Perspective: Present at the Creation
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Keywords

  • chronic dialysis
  • economic analysis
  • end-stage renal disease
  • peritoneal dialysis
  • United States Renal Data System

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