Effect of Medicare Dialysis Payment Reform on Use of Erythropoiesis Stimulating Agents

• Published in: Health services research 2015-06, Vol.50 (3), p.790-808
• Main Authors: Swaminathan, Shailender, Mor, Vincent, Mehrotra, Rajnish, Trivedi, Amal N.
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; bundled payments; Centers for Medicare and Medicaid Services (U.S.) - economics; Centers for Medicare and Medicaid Services (U.S.) - organization & administration; Costs (Law); Female; Health care policy; Health care reform; Hematinics - administration & dosage; Hematinics - economics; Hematocrit; Hemodialysis; Humans; incentive; Kidney Failure, Chronic - therapy; Legal fees; Male; Medicare; Middle Aged; Pay for performance; Pharmaceutical Policy and Utilization; Reimbursement; Reimbursement Mechanisms - economics; Reimbursement Mechanisms - organization & administration; Reimbursement, Incentive - economics; Renal dialysis; Renal Dialysis - methods; Studies; United States
• ISSN: 0017-9124; 1475-6773
• DOI: 10.1111/1475-6773.12252

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 ESAs. Data Sources CMS's Renal Information Management System. Study Design Regression discontinuity design assessing the use of ESAs 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 ESAs 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 ESAs 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 ESAs in patients who may not benefit from these agents.