RT Journal Article
SR Electronic
T1 Association between change in physician remuneration and use of peritoneal dialysis: a population-based cohort analysis
JF CMAJ Open
JO CMAJ
FD Canadian Medical Association
SP E96
OP E104
DO 10.9778/cmajo.20190132
VO 8
IS 1
A1 Trachtenberg, Aaron J.
A1 Quinn, Amity E.
A1 Ma, Zhihai
A1 Klarenbach, Scott
A1 Hemmelgarn, Brenda
A1 Tonelli, Marcello
A1 Faris, Peter
A1 Weaver, Robert
A1 Au, Flora
A1 Zhang, Jianguo
A1 Manns, Braden
YR 2020
UL http://www.cmajopen.ca/content/8/1/E96.abstract
AB Background: Health care payers are interested in policy-level interventions to increase peritoneal dialysis use in end-stage renal disease. We examined whether increases in physician remuneration for peritoneal dialysis were associated with greater peritoneal dialysis use.Methods: We studied a cohort of patients in Alberta who started long-term dialysis with at least 90 days of preceding nephrologist care between Jan. 1, 2001, and Dec. 31, 2014. We compared peritoneal dialysis use 90 days after dialysis initiation in patients cared for by fee-for-service nephrologists and those cared for by salaried nephrologists before and after weekly peritoneal dialysis remuneration increased from $0 to $32 (fee change 1, Apr. 1, 2002), $49 to $71 (fee change 2, Apr. 1, 2007), and $71 to $135 (fee change 3, Apr. 1, 2009). Remuneration for peritoneal dialysis remained less than hemodialysis until fee change 3. We performed a patient-level differences-in-differences logistic regression, adjusted for demographic characteristics and comorbidities, as well as an unadjusted interrupted time-series analysis of monthly outcome data.Results: Our cohort included 4262 patients. There was no statistical evidence of a difference in the adjusted differences-indifferences estimator following fee change 1 (0.89, 95% confidence interval [CI] 0.44–1.81), 2 (1.15, 95% CI 0.73–1.83), or 3 (1.52, 95% CI 0.96–2.40). There was no significant difference in the immediate change or the trend over time in peritoneal dialysis use between fee-for-service and salaried groups following any of the fee changes in the interrupted time-series analysis.Interpretation: We identified no statistical evidence of an increase in peritoneal dialysis use following increased fee-for-service remuneration for peritoneal dialysis. It remains unclear what role, if any, physician payment plays in selection of dialysis modality.