Clinical and Economic Value of Performing Dialysis Vascular Access Procedures in a Freestanding Office‐Based Center as Compared with the Hospital Outpatient Department among Medicare ESRD Beneficiaries

Dialysis vascular access ( DVA ) care is being increasingly provided in freestanding office‐based centers ( FOC ). Small‐scale studies have suggested that DVA care in a FOC results in favorable patient outcomes and lower costs. To further evaluate this issue, data were drawn from incident and prevalent ESRD patients within a 4‐year sample (2006‐2009) of Medicare claims ( USRDS ) on cases who receive at least 80% of their DVA care in a FOC or a hospital outpatient department ( HOPD ). Using propensity score matching techniques, cases with a similar clinical and demographic profile from these two sites of service were matched. Medicare utilization, payments, and patient outcomes were compared across the matched cohorts (n = 27,613). Patients treated in the FOC had significantly better outcomes (p < 0.001), including fewer related or unrelated hospitalizations (3.8 vs. 4.4), vascular access‐related infections (0.18 vs. 0.29), and septicemia‐related hospitalizations (0.15 vs. 0.18). Mortality rate was lower (47.9% vs. 53.5%) as were PMPM payments ($4,982 vs. $5,566). This study shows that DVA management provided in a FOC has multiple advantages over that provided in a HOPD .