Comparing Dialysis Provision and Outcomes Between Medicare Advantage and Fee-for-Service Medicare

比较 Medicare Advantage 和按服务收费 Medicare 之间的透析服务和结果

• 批准号: 10355085
• 负责人: Eugene Lin
• 金额: $ 12.38万
• 依托单位: UNIVERSITY OF SOUTHERN CALIFORNIA
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10355085
• 关键词: Affordable Care Act; Area; Caring; Chronic Disease; Contracts; Cost Savings; Data; Data Reporting; Data Set; Data Sources; Dialysis procedure; Disease Outcome; Eligibility Determination; End stage renal failure; Enrollment; Fee-for-Service Plans; Future; Healthcare; Heterogeneity; Hospitalization; Incentives; Individual; Information Systems; Insurance; Insurance Carriers; Kidney; Lead; Link; Mediation; Medicaid; Medicare; Morbidity - disease rate; Outcome; Outpatients; Ownership; Patients; Penetration; Policies; Population; Price; Privatization; Provider; Registries; Reporting; Research; Research Infrastructure; Research Personnel; Research Project Grants; Resistance; Schedule; Services; Uninsured; United States; Variant; Work; care coordination; comorbidity; cost; experience; health care service utilization; hospitalization rates; improved; improved outcome; innovation; mortality; novel; payment; provider networks; statistics; uptake

7. ABSTRACT Most patients requiring dialysis for end-stage kidney disease (ESKD) obtain Medicare, with the majority enrolling in fee-for-service (FFS or traditional) Medicare. Medicare Advantage (MA), when private insurers coordinate Medicare benefits, is an alternative to FFS Medicare. However, prior to 2021, patients with ESKD could only enroll prior to developing ESKD. Consequently, only 22% of Medicare patients with ESKD have an MA plan, compared to 36% of Medicare patients without ESKD. The 21st Century Cures Act opened MA to all patients with ESKD in 2021, and experts anticipate a large influx of enrollment into MA. Proponents of MA argue that it results in better care-coordination of chronic diseases, leading to improved outcomes and reduced costs in the non-ESKD population. It is unclear whether these findings extend to ESKD, and research on MA ESKD outcomes are conspicuously sparse, despite its imminent importance. A key explanation is a lack of available research data. The United States Renal Data System (USRDS), the dataset used for most dialysis research, almost exclusively contains data on FFS Medicare. Additionally, because MA plans and dialysis providers negotiate proprietary contracts for dialysis payment, MA dialysis reimbursements have substantial variation, making comparisons across MA plans and providers difficult. Thus, researchers have focused primarily on FFS Medicare. We will use a novel linkage between MA claims data and the USRDS dataset to investigate outcomes in the MA dialysis population. In addition to being one of the first research projects to broadly study dialysis in MA, our work will develop a research infrastructure that will make future research on MA and ESKD more accessible. A key innovation is identifying a comparable unit of dialysis treatment (and all related services) across MA plans and providers, and with FFS Medicare. In Aim 1, we will investigate whether patients with MA accrue the benefits of improved care-coordination seen in non-dialysis populations with MA. We will study whether MA results in improved outcomes at the start of dialysis (e.g., starting dialysis as outpatients) and whether prevalent patients with MA and ESKD experience fewer hospitalizations or have lower mortality. As a potential mechanism for improved care-coordination, we will explore whether MA patients are more likely to receive extra outpatient dialysis sessions over the conventional thrice weekly dialysis schedule. Aim 2 will assess heterogeneity in the MA market. We will study how market concentration at the dialysis facility, the dialysis chain, and the MA plan levels modify our findings in Aim 1. For instance, dialysis providers with few regional competitors may have more market power and, consequently, might be resistant to care-coordination and cost-saving initiatives by MA plans. The proposed work will form the impetus for a larger research effort, including an R01 application, aimed at studying the impact of the 21st Century Cures Act and of expanding MA eligibility for the dialysis population in the United States.

7。摘要 大多数需要透析终末期肾脏疾病（ESKD）的患者获得医疗保险，其中大多数 参加费用服务（FFS或传统）Medicare。私人保险公司时，医疗保险优势（MA） 协调Medicare福利，是FFS Medicare的替代方法。但是，在2021年之前，ESKD患者 只能在开发ESKD之前注册。因此，只有22％的Medicare患者患有ESKD患者 MA计划，而没有ESKD的Medicare患者中有36％。 21世纪的治疗法案向所有人开放了MA ESKD患者于2021年，专家预计将大量入学涌入MA。马的支持者 认为它会导致更好的慢性疾病协调，从而改善结果并减少 非ESKD人群的成本。目前尚不清楚这些发现是否扩展到ESKD，并研究MA ESKD的结果显然很稀疏，尽管它至关重要。一个关键的解释是缺乏 可用的研究数据。美国肾脏数据系统（USRDS），用于大多数透析的数据集 研究几乎完全包含有关FFS Medicare的数据。此外，由于MA计划和透析 提供者谈判有关透析付款的专有合同，透析报销大量 变化，使MA计划和提供商之间的比较变得困难。因此，研究人员专注于 主要是在FFS Medicare上。我们将使用MA索赔数据和USRDS数据集之间的新颖链接到 研究MA透析人群的结果。除了是最早的研究项目之一 广泛研究MA的透析，我们的工作将开发出研究基础设施，将来将来研究 MA和ESKD更容易访问。一个关键的创新是确定可比的透析治疗单位（以及所有 相关服务）跨MA计划和提供商，以及FFS Medicare。在AIM 1中，我们将调查是否 具有MA的患者在具有MA的非透析人群中看到了改善照料协调的好处。 我们将研究MA在透析开始时是否会改善结果（例如，开始透析为 门诊病人）以及流行的MA和ESKD患者是否经历了更少的住院或 降低死亡率。作为改善护理协调的潜在机制，我们将探讨MA患者是否是否 在传统的三次透析时，更有可能在传统的三次 日程。 AIM 2将评估MA市场中的异质性。我们将研究如何在 透析设施，透析链和MA计划水平在AIM 1中修改了我们的发现。例如，透析 少数地区竞争者的提供者可能具有更多的市场能力，因此，可能会抵抗 马萨诸塞州计划的照料协调和节省成本的计划。拟议的工作将构成更大的动力 研究工作，包括R01应用，旨在研究21世纪治疗法和的影响 扩大了美国透析人口的资格。