Paying for Frequent Dialysis

• Authors: Adam Wilk, Emory University; Richard A. Hirth, University of Michigan; Joseph M. Messana, University of Michigan
• Journal Title: AMERICAN JOURNAL OF KIDNEY DISEASES
• Volume: Volume 74, Number 2
• Publisher: W B SAUNDERS CO-ELSEVIER INC | 2019-08-01, Pages 248-255
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1053/j.ajkd.2019.01.027
• Subjects: Engineering, Biomedical; Health Sciences, Medicine and Surgery
• Keywords: Science & Technology; Life Sciences & Biomedicine; Urology & Nephrology; AMBULATORY PERITONEAL-DIALYSIS; IN-CENTER HEMODIALYSIS; DAILY HOME HEMODIALYSIS; QUALITY-OF-LIFE; NOCTURNAL HEMODIALYSIS; PAYMENT SYSTEM; COST-UTILITY; MORTALITY; SURVIVAL; PATIENT

Abstract

In late 2017, the 7 regional contractors responsible for paying dialysis claims in Medicare proposed new payment rules that would restrict payment for hemodialysis treatments in excess of 3 weekly to exceptional acute-care circumstances. Frequent hemodialysis is performed more frequently than the traditional thrice-weekly pattern, and many stakeholders—patients, providers, dialysis machine manufacturers, and others—have expressed concern that these payment rules will inhibit the growth of this treatment modality's use among US dialysis patients. In this Perspective, we explain the role of these contractors in the context of Medicare's in-center hemodialysis-centric dialysis payment system and assess how well this system accommodates the higher treatment frequencies of both peritoneal dialysis and frequent hemodialysis. Then, given the available evidence concerning the relative effectiveness of these modalities versus thrice-weekly in-center hemodialysis and trends in their use, we discuss options for modifying Medicare's payment system to support frequent dialysis.