"G-code" Reimbursement and Outcomes in Hemodialysis

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DESCRIPTION (provided by applicant): This project will combine disciplines of nephrology and health economics to study how the economic incentive for nephrologists to see patients with end-stage renal disease (ESRD) more frequently, as created by the Centers for Medicare and Medicaid Services in January 2004 through "G-codes" for physician reimbursement, affected patient outcomes. I hypothesize that the increased frequency of face-to-face visits by healthcare providers following introduction of "G-codes" led to changes in health outcomes in patients with ESRD who are treated by physicians affected by "G-codes". This research training program will provide me to with the background for a career as a physician-scientist investigating how economic incentives can improve patient-related outcomes and lead to more cost-effective care of people with kidney disease. Understanding how economic incentives impact care of patients with kidney disease is important as kidney disease is becoming increasingly common and because policies put in place by the United States government largely govern the economic incentives for treatment of end-stage renal disease. Government policy has such a significant impact on economic incentives for treatment of patients with ESRD because a large majority of patients with ESRD are covered primarily by Medicare.1 While the government has made efforts in the past to alter economic incentives for treatment of patients with ESRD, and continues to propose additional changes to economic incentives, it is not certain whether these changes in economic incentives affect patient outcomes. While investigating the affect that one government policy, "G-codes," have had on health outcomes in patients with end-stage renal disease, I will collaborate with mentors within the departments of Health Services Research and Nephrology, and will obtain a Masters Degree in Health Services Research. This will provide me with the background necessary to conduct the proposed research on "G-codes" in addition to a future career in health economics and outcomes research. PUBLIC HEALTH RELEVANCE: Understanding how economic incentives impact treatment of patients with kidney disease is important from a public health perspective because kidney disease is common and frequently co-exists with other common conditions such as cardiovascular disease, diabetes, and hypertension. Kidney disease also disproportionately affects vulnerable populations such as the elderly and poor. As the cost of treating kidney disease continues to increase, an understanding of economic incentives will play a major role in developing future strategies to improve in healthcare organization, delivery, financing, utilization, outcomes and effectiveness in patients with kidney disease.