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. 2020 Apr 7;323(13):1314-1316.
doi: 10.1001/jama.2020.0704.

Medicare Enrollment Among Patients With End-Stage Kidney Disease Receiving Dialysis in Outpatient Facilities Between 2005 and 2016

Abby Hoffman  1 , Caroline E Sloan  2 , Matthew L Maciejewski  3 , Virginia Wang  1
Affiliations

Medicare Enrollment Among Patients With End-Stage Kidney Disease Receiving Dialysis in Outpatient Facilities Between 2005 and 2016

Abby Hoffman et al. JAMA. .

Abstract

This study characterizes annual changes in enrollment of Medicare and non-Medicare patients treated at dialysis facilities before and after 2011 payment reforms and 2014 Affordable Care Act changes that influenced reimbursements.

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Conflict of interest statement

Conflict of Interest Disclosures: Drs Sloan, Maciejewski, and Wang reported receiving grant funding from the Department of Veterans Affairs Health Services Research and Development Service (Maciejewski-RCS 10-391) and the Durham Center of Innovation to Accelerate Discovery and Practice Transformation (CIN 13-410) at the Durham VA Health Care System. Dr Maciejewski reported owning stock in Amgen due to his spouse’s employment. Drs Maciejewski and Wang reported receiving funding from the National Institutes of Health. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Annual Change in Medicare and Non-Medicare Enrollment Reported by Dialysis Facilities, 2005-2016
The data points represent the mean percentage of patients at dialysis facilities; the annual change (95% CI) represents patients with non-Medicare coverage. Direct tests of differences between periods indicated that the growth in non-Medicare coverage was statistically significantly different between 2011-2014 and 2005-2011 (6.70 percentage points; 95% CI, 6.58-6.81), but not between 2014-2016 and 2011-2014 (–0.16 percentage points; 95% CI, –0.36 to 0.04). The slopes were generated using a generalized least-squares model with random effects, linear splines, and adjustment for facility-level characteristics (profit status, membership in 2 of the largest chains) and hospital referral region characteristics (US region, competition [Herfindahl Index], percentage of patients aged <65 years with end-stage kidney disease). ACA indicates Affordable Care Act.
Figure 2.
Figure 2.. Annual Change in Non-Medicare Enrollment by Dialysis Facilities’ Profit and Large Chain Status, 2005-2016
The figure shows the mean percentage of patients at the facility level who do not have Medicare coverage. Facilities are categorized by affiliation with 1 of the 2 largest dialysis chains and by profit status. These 2 categories are highly collinear with a correlation of 53.3%. ACA indicates Affordable Care Act.
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Comment in

References

    1. US Renal Data System USRDS 2018 Annual Data Report: Atlas of End-Stage Renal Disease in the United States. National Institute of Diabetes and Digestive and Kidney Diseases; 2018.
    1. Centers for Medicare & Medicaid Services Medicare Program; conditions for coverage for end-stage renal disease facilities-third party payment. Fed Regist. 2016;81(240)90211-90228. - PubMed
    1. Jost T. CMS acts on premium payments by dialysis facilities, special enrollment period eligibility. Health Affairs blog. December 13, 2016. Accessed August 15, 2019. https://www.healthaffairs.org/do/10.1377/hblog20161213.057930/full/ - DOI
    1. Sloan CE, Coffman CJ, Sanders LL, et al. . Trends in peritoneal dialysis use in the United States after Medicare payment reform. Clin J Am Soc Nephrol. 2019;14(12):1763-1772. doi:10.2215/CJN.05910519 - DOI - PMC - PubMed
    1. Dialysis Patient Citizens et al v Burwell et al, Case No. 4:2017cv00016 (ED Tex 2017).

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