Reforming Medicare's dialysis payment policies

Implications for patients with secondary hyperparathyroidism

Charu Gupta, Glenn M. Chertow, Mark T. Linthicum, Karen Van Nuys, Vasily Belozeroff, Leigh Quarles, Darius N. Lakdawalla

Research output: Contribution to journalArticle

Abstract

Objective To demonstrate how expanding services covered by a "bundled payment" can also expand variation in the costs of treating patients under the bundle, using the Medicare dialysis program as an example.

Data Sources/Study Setting Observational claims-based study of 197,332 Medicare hemodialysis beneficiaries enrolled for at least one quarter during 2006-2008.

Study Design We estimated how resource utilization (all health services, dialysis-related services, and medications) changes with intensity of secondary hyperparathyroidism (sHPT) treatment.

Data Extraction Methods Using Medicare claims, a patient-quarter level dataset was constructed, including a measure of sHPT treatment intensity.

Principal Findings Under the existing, narrow dialysis bundle, utilization of covered services is relatively constant across treatment intensity groups; under a broader bundle, it rises more rapidly with treatment intensity.

Conclusions The broader Medicare dialysis bundle reimburses providers uniformly, even though patients treated more intensively for sHPT cost more to treat. Absent any payment adjustments or efforts to ensure quality, this flat payment schedule may encourage providers to avoid high-intensity patients or reduce their treatment intensity. The first incentive harms efficiency. The second may improve or worsen efficiency, depending on whether it reduces appropriate or inappropriate treatment.

Original languageEnglish (US)
Pages (from-to)1925-1943
Number of pages19
JournalHealth Services Research
Volume49
Issue number6
DOIs
StatePublished - Dec 1 2014

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Secondary Hyperparathyroidism
Medicare
Dialysis
Therapeutics
Social Adjustment
Costs and Cost Analysis
Information Storage and Retrieval
Health Services
Observational Studies
Renal Dialysis
Motivation
Appointments and Schedules

All Science Journal Classification (ASJC) codes

  • Health Policy

Cite this

Gupta, C., Chertow, G. M., Linthicum, M. T., Van Nuys, K., Belozeroff, V., Quarles, L., & Lakdawalla, D. N. (2014). Reforming Medicare's dialysis payment policies: Implications for patients with secondary hyperparathyroidism. Health Services Research, 49(6), 1925-1943. https://doi.org/10.1111/1475-6773.12202

Reforming Medicare's dialysis payment policies : Implications for patients with secondary hyperparathyroidism. / Gupta, Charu; Chertow, Glenn M.; Linthicum, Mark T.; Van Nuys, Karen; Belozeroff, Vasily; Quarles, Leigh; Lakdawalla, Darius N.

In: Health Services Research, Vol. 49, No. 6, 01.12.2014, p. 1925-1943.

Research output: Contribution to journalArticle

Gupta, C, Chertow, GM, Linthicum, MT, Van Nuys, K, Belozeroff, V, Quarles, L & Lakdawalla, DN 2014, 'Reforming Medicare's dialysis payment policies: Implications for patients with secondary hyperparathyroidism', Health Services Research, vol. 49, no. 6, pp. 1925-1943. https://doi.org/10.1111/1475-6773.12202
Gupta, Charu ; Chertow, Glenn M. ; Linthicum, Mark T. ; Van Nuys, Karen ; Belozeroff, Vasily ; Quarles, Leigh ; Lakdawalla, Darius N. / Reforming Medicare's dialysis payment policies : Implications for patients with secondary hyperparathyroidism. In: Health Services Research. 2014 ; Vol. 49, No. 6. pp. 1925-1943.
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