FINANCIAL IMPLICATIONS TO MEDICARE FROM CHANGING THE DIALYSIS MODALITY MIX UNDER THE BUNDLED PROSPECTIVE PAYMENT SYSTEM
FINANCIAL IMPLICATIONS TO MEDICARE FROM CHANGING THE DIALYSIS MODALITY MIX UNDER THE BUNDLED PROSPECTIVE PAYMENT SYSTEM
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DOI：
10.3747/pdi.2013.00305
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发表时间：
2014-11-01
影响因子：
2.8
通讯作者：
Golper, Thomas A.
中科院分区：
文献类型：
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作者：
Liu, Frank X.;Walton, Surrey M.;Golper, Thomas A.
背景：治疗终末期肾病（ESRD）的经济负担持续增加。作为应对措施之一，Medicare 为透析患者实施了捆绑式前瞻性支付系统（PPS，包括注射药物），该系统自 2011 年 1 月 1 日起生效。本研究调查了新 PPS 下接受腹膜透析 (PD)、中心血液透析 (ICHD) 和家庭血液透析 (HHD) 的患者分布变化对医疗保险的 5 年预算影响。方法：创建了基于 Excel 的预算影响模型来评估与透析相关的医疗保险成本。该模型考虑了透析通路的建立、当前每月按人头付费的医生为 ESRD 支付的费用、医疗保险透析付款（包括启动费用）、培训、口服药物费用以及不良事件的成本和概率，包括通路故障、通路感染住院、肺炎、败血症和心血管事件。美国肾脏数据系统 (USRDS) 数据用于预测不同时间段的美国医疗保险透析患者人数。基线情景假设 PD (7.7%)、HHD (1.3%) 和 ICHD (91.0%) 在 5 年内保持稳定分布。三种比较情景使PD和HHD的比例每年提高（1）1％和0.5％，（2）2％和0.75％，（3）3％和1％；第四种方案保持 HHD 不变，每年将 PD 降低 1%。 结果：在捆绑式 PPS 下，5 年内将 PD 和 HHD 从 7.7% 和 1.3% 增加的方案导致 Medicare 累计节省 1.148 亿美元（方案 1，第 5 年为 11.7% PD 和 3.3% HHD），2.329 亿美元（方案 2，第 15 年为 15.7% PD 和 3.3% HHD）。第 5 年为 4.3% HHD），以及 3.509 亿美元（场景 3，第 5 年为 19.7% PD 和 5.3% HHD）。当 PD 人口从 2013 年的 7.7% 下降到 2017 年的 3.7%（HHD 人口不变）时，透析患者的医疗保险支付总额增加了超过 1.212 亿美元。结论：在医疗保险捆绑 PPS 下，相对于 ICHD，增加 PD 和 HHD 患者的比例可以大大节省医疗保险的透析相关费用。
Background: The economic burden of treating end-stage renal disease (ESRD) continues to grow. As one response, effective January 1, 2011, Medicare implemented a bundled prospective payment system (PPS, including injectable drugs) for dialysis patients. This study investigated the 5-year budget impact on Medicare under the new PPS of changes in the distribution of patients undergoing peritoneal dialysis (PD), in-center hemodialysis (ICHD), and home hemodialysis (HHD).Methods: An Excel-based budget impact model was created to assess dialysis-associated Medicare costs. The model accounted for dialysis access establishment, the current monthly capitation physician payment for ESRD, Medicare dialysis payments (including start-up costs), training, oral drug costs, and the costs and probabilities of adverse events including access failure, hospitalization for access infection, pneumonia, septicemia, and cardiovascular events. United States Renal Data System (USRDS) data were used to project the US Medicare dialysis patient population across time. The baseline scenario assumed a stable distribution of PD (7.7%), HHD (1.3%) and ICHD (91.0%) over 5 years. Three comparison scenarios raised the proportions of PD and HHD by (1) 1% and 0.5%, (2) 2% and 0.75%, and (3) 3% and 1% each year; a fourth scenario held HHD constant and lowered PD by 1% per year.Results: Under the bundled PPS, scenarios that increased PD and HHD from 7.7% and 1.3% over 5 years resulted in cumulative savings to Medicare of $114.8M (Scenario 1, 11.7% PD and 3.3% HHD at year 5), $232.9M (Scenario 2, 15.7% PD and 4.3% HHD at year 5), and $350.9M (Scenario 3, 19.7% PD and 5.3% HHD at year 5). When the PD population was decreased from 7.7% in 2013 to 3.7% by 2017 with a constant HHD population, the total Medicare payment for dialysis patients increased by over $ 121.2M.Conclusions: Under Medicare bundled PPS, increasing the proportion of patients on PD and HHD vs ICHD could generate substantial savings in dialysis-associated costs to Medicare.