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 大多数需要透析治疗终末期肾病（ESKD）的患者获得医疗保险， 参加按服务收费（FFS或传统）医疗保险。医疗保险优势（MA），当私人保险公司 协调医疗保险福利，是FFS医疗保险的替代方案。然而，在2021年之前，ESKD患者 只能在开发ESKD之前入组。因此，只有22%的ESKD医疗保险患者 MA计划，相比之下，36%的医疗保险患者没有ESKD。《21世纪世纪治愈法案》向所有人开放了MA 2021年ESKD患者，专家预计将有大量入组MA。MA的支持者 认为它可以更好地协调慢性病的护理，从而改善结果并减少 非ESKD人群的成本。目前还不清楚这些发现是否延伸到ESKD和MA的研究 ESKD的结果是显着稀疏，尽管其迫在眉睫的重要性。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FFS医疗保险的数据。此外，由于MA计划和透析 供应商谈判透析付款的专有合同，MA透析报销有很大的 变化，使得在MA计划和提供者之间进行比较变得困难。因此，研究人员集中 主要是FFS医疗。我们将使用MA索赔数据和USRDS数据集之间的新型联系， 研究MA透析人群的结局。除了是第一个研究项目之一， 在MA广泛研究透析，我们的工作将开发一个研究基础设施，使未来的研究 MA和ESKD更容易获得。一个关键的创新是确定一个可比较的透析治疗单位（以及所有 相关服务）跨MA计划和提供商，并与FFS Medicare。在目标1中，我们将研究 MA患者在非透析MA人群中观察到的护理协调改善获益。 我们将研究MA是否会在透析开始时改善结局（例如，开始透析， 门诊患者）以及MA和ESKD的流行患者是否经历更少的住院治疗或 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 更有可能接受额外的门诊透析治疗，而不是常规的每周三次透析 schedule.目标2将评估并购市场的异质性。我们将研究市场集中度如何在 透析设施、透析链和MA计划水平修改了我们在目标1中的发现。例如，透析 区域竞争对手较少的供应商可能拥有更大的市场力量，因此可能会抵制 通过千年评估计划开展护理协调和成本节约举措。拟议的工作将推动一个更大的 研究工作，包括R01应用程序，旨在研究21世纪世纪治愈法的影响， 扩大美国透析人群的MA资格。