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Effect of Medicare Dialysis Payment Reform on Use of Erythropoiesis Stimulating Agents
Author(s) -
Swaminathan Shailender,
Mor Vincent,
Mehrotra Rajnish,
Trivedi Amal N.
Publication year - 2015
Publication title -
health services research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.706
H-Index - 121
eISSN - 1475-6773
pISSN - 0017-9124
DOI - 10.1111/1475-6773.12252
Subject(s) - erythropoiesis , dialysis , medicine , payment , intensive care medicine , business , anemia , finance
Objective In 2011, the Centers for Medicare and Medicaid Services ( CMS ) replaced fee‐for‐service reimbursement for erythropoiesis stimulating agents ( ESAs ) with a fixed‐sum bundled payment for all dialysis‐related care and pay‐for‐performance incentives to discourage maintaining patients' hematocrits above 36 percent. We examined the impact of the new payment policy on the use of ESA s. Data Sources CMS's Renal Information Management System. Study Design Regression discontinuity design assessing the use of ESA s by hematocrit level before and after the implementation of the payment policy change. Data Extraction Secondary data from 424,163 patients receiving hemodialysis treatment between January 2009 and June 2011. Principal Findings The introduction of bundled payments with pay‐for‐performance initiatives was associated with an immediate and substantial decline in the use of ESA s among patients with hematocrit >36 percent and little change in the use of ESAs among patients with hematocrit ≤36 percent. In the first two quarters of 2011, the use of ESA s during dialysis fell by about 7–9 percentage points among patients with hematocrit levels >36 percent. No statistically significant differences in ESA use were observed at the thresholds of 30 or 33 percent. Conclusions CMS 's payment reform for dialysis care reduced the use of ESA s in patients who may not benefit from these agents.