Original InvestigationDialysis TherapyChanges in Medicare Reimbursement and Patient-Nephrologist Visits, Quality of Care, and Health-Related Quality of Life
Section snippets
Subjects and Facilities
We performed a retrospective cohort study of dialysis-related outcomes before and after the January 1, 2004, change in Medicare reimbursement. We included patients who received in-center hemodialysis from January 1, 2003, to July 31, 2004, at 12 free-standing not-for-profit facilities that are part of a single chain in northeast Ohio. Patients receiving peritoneal dialysis or home hemodialysis were not included in this study. Patients with a previous renal transplant who otherwise met inclusion
Subject Characteristics
Of 2,623 patients receiving hemodialysis from January 2003 to July 2004, a total of 2,043 patients (78%) were treated for at least 90 days. Of these, 1,600 patients (61%) were treated before and after the Medicare reimbursement change for a total of at least 6 months during the study. Subject characteristics for these 1,600 subjects are listed in Table 1.
Patient-Nephrologist Visits
Of 59,841 face-to-face nephrologist or physician extender visits, 52,626 (88%) were nephrologist hemodialysis rounding visits, 5,944 (10%)
Discussion
In our study, the CMS reimbursement change was associated with a significant and immediate increase in number of patient-nephrologist visits. As shown in Fig 1, mean number of visits was highly stable after the change was instituted. However, in 7 months of follow-up after the change, no clinically important improvement was observed across a wide range of outcomes. These outcomes include both subjective and objective measures. All these outcomes have well-documented importance. Although the
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Impact of payment model on the behaviour of specialist physicians: A systematic review
2020, Health PolicyCitation Excerpt :Because the reform only targeted hemodialysis patients, it was associated with a small but significant decrease in the average absolute probability of patients using home dialysis modalities, an unintended consequence [29]. The blended capitation reform was associated with some small, but significant improvements in quality of care, including a decrease in 30-day readmission for fluid overload [20] and increase in a measurement of the adequacy of dialysis treatment [28]. This systematic review identified 11 studies assessing seven unique payment reforms.
Hemodialysis Hospitalizations and Readmissions: The Effects of Payment Reform
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2013, American Journal of Kidney DiseasesAdequacy of dialysis clinic staffing and quality of care: A review of evidence and areas of needed research
2011, American Journal of Kidney DiseasesCitation Excerpt :With these overlapping considerations in mind, the suggested research with nephrologists, nurses, PCTs, dietitians, and social workers are discussed separately. Given the many unknowns about the long-term effects of nephrologist-patient contacts on morbidity and mortality,19-26 several areas of research can be suggested. One bears on the long-held assumption that more frequent contacts will invariably improve outcomes.89
Originally published online as doi:10.1053/j.ajkd.2005.06.012 on August 22, 2005.