Effect of Medicare dialysis payment reform on use of erythropoiesis stimulating agents.
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.
['Swaminathan|Shailender|S|', 'Mor|Vincent|V|', 'Mehrotra|Rajnish|R|', 'Trivedi|Amal N|AN|']
D000368:Aged D000369:Aged, 80 and over D014487:Centers for Medicare and Medicaid Services, U.S. D005260:Female D006397:Hematinics D006400:Hematocrit D006801:Humans D007676:Kidney Failure, Chronic D008297:Male D008875:Middle Aged D012051:Reimbursement Mechanisms D012052:Reimbursement, Incentive D006435:Renal Dialysis D014481:United States
Medicare bundled payments incentive Renal dialysis