10 Apr Fewer Kidney Failure Patients Rely on Medicare for Dialysis
MedicalResearch.com Interview with:
Lead and Senior coauthors contributing to this interview:
Abby Hoffman
Abby Hoffman, BA is a Pre-Doctoral Fellow in Population Health Sciences at Duke University and a PhD Candidate in Health Policy and Management
University of North Carolina at Chapel Hill.
Dr. Virginia Wang
Virginia Wang, PhD, MSPH is an Associate Professor in the Department of Population Health Sciences, Associate Director of the Center for Health Innovation and Outcomes Research, and Core Faculty in the
Margolis Center for Health Policy at Duke University and Investigator at the Durham VA HSR&D Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT).
MedicalResearch.com: What is the background for this study?
Response: It is well established that healthcare providers are sensitive to changes in price, though their behavioral response varies. Dialysis facilities are particularly responsive to changes in Medicare reimbursement. Many dialysis patients are eligible for Medicare regardless of age, but dialysis facilities generally receive significantly higher reimbursement from private insurers than from Medicare.
In 2011, Medicare implemented a new prospective bundled payment for dialysis that was expected to decrease Medicare payment and reduce overall revenues flowing into facilities. Then the Affordable Care Act (ACA) rules against refusing to insure patients for preexisting conditions and the 2014 ACA Marketplace provided an additional avenue for patients to purchase private insurance. As a result of these policies, dialysis facilities had a strong motivation and opportunity to increase the share of patients with private insurance coverage.
We were interested in understanding whether dialysis facilities were shifting their payer mix away from Medicare, possibly in response to these policy changes.
MedicalResearch.com: What are the main findings? How has the change in Medicare enrollment affected the viability of for-profit dialysis units?
Response: We used data from annual facility surveys on the numbers of their patients by Medicare enrollment status (enrolled, in the process of applying for Medicare, or neither enrolled nor in the process of applying for Medicare). We found a facility-level movement away from a Medicare payer mix and towards a non-Medicare payer mix beginning in 2011 and continuing through 2016. For example, from 2005 to 2011, on average, non-Medicare patients made up only about 4% of a dialysis facility’s payer mix. By 2016, non-Medicare patients made up 34% of a facility’s payer mix, on average. This movement was more pronounced in facilities that were part of large chains and facilities that were for-profit.
These results point to potentially increasing revenues and profits for most facilities. Though it is important to note that our data are not clear on exactly what types of insurance (or lack of insurance) are supplanting Medicare coverage. We can infer that, because most dialysis patients are eligible for Medicare, patients are receiving private insurance coverage rather than remaining uninsured.
MedicalResearch.com: What should readers take away from your report?
Response: We empirically show a signal that facilities are potentially responding to changes in Medicare and ACA policies, in part by shifting away from Medicare.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: This was a descriptive observational study and further investigation is needed to assess the impact facilities’ shift in payer mix has on patients and on the healthcare system more broadly. We see movement away from Medicare coverage at the facility-level, but, with the data in this study, we cannot determine what is happening at the patient-level. Is the patient-level movement away from Medicare as stark as the facility-level data make it appear? What is replacing Medicare for dialysis patients now? How? What benefits and harms are associated with diminished Medicare reliance?
We have no new disclosures to add since the publication was accepted and printed for publication.
Citation:
Hoffman A, Sloan CE, Maciejewski ML, Wang V. Medicare Enrollment Among Patients With End-Stage Kidney Disease Receiving Dialysis in Outpatient Facilities Between 2005 and 2016. JAMA. 2020;323(13):1314–1316. doi:10.1001/jama.2020.0704
https://jamanetwork.com/journals/jama/article-abstract/2764171
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Last Updated on April 10, 2020 by Marie Benz MD FAAD